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Paediatric Hospital (paediatric + hospital)
Kinds of Paediatric Hospital Selected Abstracts27 years of croup: An update highlighting the effectiveness of 0.15 mg/kg of dexamethasoneEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2009Milana Dobrovoljac Abstract Objective: To update an earlier observational study (1980,1995) documenting dramatic improvements in the management of croup with the mandatory use of a single oral dose of dexamethasone and to ascertain whether a reduction from a dose of 0.6 to 0.15 mg/kg in 1995 maintained these improved outcomes over the next 11 years. Methods: We evaluated retrospectively the experience of children with croup in Princess Margaret Hospital for Children, the only tertiary paediatric hospital in Western Australia, over the subsequent 11 year period from 1996 to 2006 inclusive. Data were updated from ED, general hospital and the intensive care unit records to show the numbers of children presenting to the hospital, admitted, transferred to intensive care and intubated. We also recorded the length of hospital stay and representation rate of all cases within 7 days. Results: The dramatic improvements in outcomes for croup, including reduced admission rates, length of stay, transfers to the intensive care unit, intensive care unit days and number of intubations as reported in our earlier paper, were maintained using 0.15 mg/kg dexamethasone. Admission rates for croup have fallen from 30% in the early 1990s to less than 15% in recent years, whereas the representation rate has risen slightly. Conclusion: The improved outcomes for children with croup presenting to our paediatric ED have been maintained with a reduced, single oral dose of 0.15 mg/kg of dexamethasone. [source] Investigation of the rate of meningitis in association with urinary tract infection in infants 90 days of age or youngerEMERGENCY MEDICINE AUSTRALASIA, Issue 5 2007Peter J Vuillermin Abstract Objective: To test the hypothesis that urinary tract infections (UTI) in young infants are rarely associated with meningitis. Methods: We undertook a review of the laboratory results from 322 infants, 90 days of age or younger, with an admission or discharge diagnosis of UTI or meningitis. The study was conducted in a tertiary paediatric hospital. The primary outcome measure was the incidence of coexisting urinary tract and cerebrospinal fluid sepsis. Results: In total, 161 of the 322 (50%) infants with an admission or discharge diagnosis of UTI or meningitis were subsequently shown to have a culture-proven UTI. Of the children with a culture-proven UTI, 75 (47%) had cerebrospinal fluid obtained. We detected one case of probable bacterial meningitis in association with UTI. Conclusion: UTI is rarely associated with meningitis in infants 90 days of age or younger. [source] Monitoring nutritional status accurately and reliably in adolescents with anorexia nervosaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2009Andrew C Martin Aim: Accurate assessment of nutritional status is a vital aspect of caring for individuals with anorexia nervosa (AN) and body mass index (BMI) is considered an appropriate and easy to use tool. Because of the intense fear of weight gain, some individuals may attempt to mislead the physician. Mid-upper arm circumference (MUAC) is a simple, objective method of assessing nutritional status. The setting is an eating disorders clinic in a tertiary paediatric hospital in Western Australia. The aim of this study is to evaluate how well MUAC correlates with BMI in adolescents with AN. Methods: Prospective observational study to evaluate nutritional status in adolescents with AN. Results: Fifty-five adolescents aged 12,17 years with AN were assessed between January 1, 2004 and January 1, 2006. MUAC was highly correlated with BMI (r = 0.79, P < 0.001) and individuals with MUAC ,20 cm rarely required hospitalisation (negative predictive value 93%). Conclusions: MUAC reflects nutritional status as defined by BMI in adolescents with AN. Lack of consistency between longitudinal measurements of BMI and MUAC should be viewed suspiciously and prompt a more detailed nutritional assessment. [source] Discussing withdrawing and withholding of life-sustaining medical treatment in a tertiary paediatric hospital: A survey of clinician attitudes and practicesJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7-8 2008Tom Forbes Aim: To better understand current attitudes and practices relating to discussions concerning the withholding and withdrawing of life-sustaining medical treatment (WWLSMT) among medical staff in the paediatric setting. Methods: An anonymous online survey of paediatricians (senior medical staff , SMS) and paediatric trainees (junior medical staff , JMS) likely to be involved in the care of children with life limiting illness. Results: A total of 162 responses were obtained (response rate 42%). SMS indicated feeling more comfortable with their abilities to discuss WWLSMT than JMS. Barriers to discussing WWLSMT were numerous and included clinician concerns about family readiness for the discussion, prognostic uncertainty, family disagreement with the treating team regarding the child's prognosis/diagnosis and concerns about how to manage family requests for treatments that are not perceived to be in the child's best interests. Fifty-eight per cent of JMS and 35.8% of SMS reported receiving no specific communication training regarding WWLSMT. Most learned through experience and by observing more senior colleagues. There was a high level of support for additional training in this area and for the provision of resources such as discussion guidelines and a structured form for documenting the outcomes WWLSMT discussions. Conclusion: The majority of JMS feel less comfortable with their abilities to facilitate these discussions than their senior colleagues. The results of this study suggest that although confidence correlates with experience, junior and senior clinicians are eager to improve their skills through ongoing professional development and the provision of resources. The education needs of JMS and SMS appear to be different. [source] Use of the Internet by parents of paediatric patientsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2006Brynn K Wainstein Aim: We aimed to determine the rate of Internet use for obtaining medical information by health-care patients at a tertiary paediatric hospital, whether the Internet may influence patients' attitudes to health-care services and health-care providers and whether patients would prefer the assistance of a professional informatics officer. Methods: An anonymous questionnaire randomly distributed to 450 subjects at Sydney Children's Hospital, Sydney, Australia. Results: A total of 294 (65%) questionnaires were returned. Overall Internet use for medical information was 64% (189/294). Most (97%; 183/189) respondents reported ,wanting to know more' as the reason they sought information on the Internet. Eighty-eight per cent (167/189) of respondents reported that they trust their doctor more than the Internet. Twenty-one per cent (39/189) had presented their doctor with information about which he/she was unaware and 18% (34/189) had altered a health-care decision because of information found on the Internet. The Internet had influenced questions asked of doctors in 83% (156/189). Eighty-six per cent (252/294) of all respondents were in favour of professional assistance to obtain medical information. Conclusion: A large number of patients use the Internet to find information that influences their attitudes to health care. The services of a medical informatics professional would likely benefit both patients and doctors. [source] Obesity and under-nutrition in a tertiary paediatric hospitalJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5-6 2004J O'Connor Objective: (i) To determine the prevalence of over- and under-nutrition in both inpatients and outpatients in a tertiary paediatric hospital; (ii) to compare the prevalence of over-nutrition with that in the Australian community and (iii) to determine whether nutritional status has an impact on length of stay in hospital. Methods: Patients aged over 12 months were proportionately sampled from medical and surgical wards and outpatient clinics. Data were collected for 245 inpatients (54% male) and 272 outpatients (55% male). Children's height, weight and body mass index (kg/m2) were measured. Overweight, obesity and under-nutrition were defined according to international criteria. Prevalence of overweight and obesity was compared with that in the 1995 Australian National Nutrition Survey (NNS). Results: Similar proportions of inpatients and outpatients were underweight (6%) and wasted (4%). The prevalence of overweight and obesity in inpatients (22%) was similar to the NNS but was significantly higher in outpatients (32%, P < 0.0001). In a regression model to predict inpatient length of stay, nutritional status (P = 0.004) and the interaction between age and nutritional status (P = 0.009) were significant predictors. For over-nourished inpatients, length of stay increased significantly with age. For normally nourished and under-nourished inpatients, length of stay was relatively constant, regardless of age. Conclusions: There is a high prevalence of over-nutrition in paediatric patients, and increased length of stay for older over-nourished inpatients. These issues need to be addressed in terms of opportunities for intervention and impact on hospital resources. [source] Perception of fear, distress and pain by parents of children undergoing a micturating cystourethrogram: A prospective studyJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2001T Srivastava Objectives: To investigate whether parents' expectations of their child's fear, distress or pain during a micturating cystourethrogram (MCU) are realized. Methodology: Prospective study in which parents were asked to fill out two questionnaires using a visual analogue scale, one before (pre) and the other after the MCU procedure (post), was conducted at a tertiary level paediatric hospital in Sydney, Australia. The questionnaires were designed to compare the parents'anticipated and experienced anxiety about their child's procedure and their perception of fear, distress and pain in their child during and after the procedure. The parents' satisfaction with information provided to them on the procedure was also recorded. Twenty-five parents participated in the study. Results: There were significant differences between anticipated and experienced parental anxiety. Parents' reporting of fear, distress and pain in their child during the MCU and after the procedure was lower than they had anticipated. There was a significant correlation between the parents' anxiety and their perception of severity of their child's fear (r = 0.52, P = 0.009), distress (r = 0.48, P = 0.017) and pain (r = 0.50, P = 0.01) during the procedure, but less so with the child's distress after the procedure (r = 0.39, P = 0.059). The parents were satisfied with the information given to them regarding the MCU procedure. Conclusions: Parents' perception of their child's fear, distress and pain during the MCU, as well as distress following the MCU, was not as severe as they had anticipated. Parental anxiety is an important factor in the perception of fear, distress and pain in children during and after the procedure. [source] The changing pattern of diagnosis of infantile cholestasisJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1 2001MO Stormon Objective: Cholestatic liver disease in infancy is caused by a wide range of conditions. This study reviews the pattern of diagnosis of infants with cholestasis presenting to a tertiary referral paediatric hospital in Sydney, Australia, during a 12-year period (1985,96). Methodology: Infants aged less than 6 months with cholestasis were identified retrospectively from hospital records and data retrieved from the medical records. Results: There were 205 infants identified as having cholestatic liver disease. The aetiology of the cholestasis was idiopathic in 25%, metabolic/genetic in 23%, and due to obstruction in 20%, parenteral nutrition in 20%, infection in 9% and bile duct hypoplasia in 3%. Conclusions: This study highlights the changing patterns of diagnosis of cholestatic liver disease in infants at a tertiary paediatric facility, demonstrating that up to 50% of cases are now due to genetic/metabolic diseases or parenteral nutrition, and a high proportion are due to idiopathic disease. [source] Safety of the Canadian blood supply in 1980,85: using a paediatric cohort for risk assessment of human immunodeficiency virus (HIV) infectionPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2001King The risk of HIV from transfusions in Canada in the period 1980,85 was estimated, using the information from a transfused paediatric cohort. Children who were transfused between January 1980 and November 1985 at a tertiary care paediatric hospital were contacted by letter. With this notification, HIV testing for recipients was recommended. HIV testing histories were obtained. The number tested for HIV was estimated from the questionnaire responses and from data matching with the HIV-testing laboratory. Cases of HIV infection were identified through multiple sources. In this cohort, 11 028 children were transfused a mean of 21 units. Of the 10 220 living recipients, the estimated proportion tested for HIV was 86% to 91%. Thirty-one cases of HIV infection were identified, representing 0.28% of the cohort but 0.34% of those expected to have been tested. The estimated HIV incidence per 1000 units transfused ranged from 0.028 [95% CI 0.0007, 0.155] in 1980 to 0.445 [95% CI 0.2592, 0.712] in 1985. This suggests that the risk of HIV from transfusions in Canada continued to rise until the implementation of HIV testing of donors in November 1985. [source] Prevalence of laryngomalacia in children presenting with sleep-disordered breathing,,งถTHE LARYNGOSCOPE, Issue 8 2010Mahilravi Thevasagayam FRCS(Ed) FRCS (ORL-HNS) Abstract Objective: To determine the prevalence of laryngomalacia among children presenting with symptoms of sleep-disordered breathing (SDB). Method: A retrospective observational study was conducted at a tertiary care paediatric hospital. All children presenting with SDB during a 55-month period were investigated using sleep nasopharyngoscopy (SNP). Patients who had laryngomalacia were identified. Patients who did not present primarily with SDB, or were not examined with SNP were excluded. Data for analysis was collected from a prospectively kept surgical database and medical records. This included patients' demographics, symptoms (including symptoms in infancy), diagnoses, SNP findings, overnight pulse oximetry findings, and treatment. Results: We identified 358 patients with documented primary diagnosis of SDB and who had undergone SNP. Fourteen of these also had a documented diagnosis of laryngomalacia, giving a prevalence rate of 3.9%. Three children were syndromic, and one had cerebral palsy in addition to SDB and laryngomalacia. Three children were obese, and three children had gastroesophageal reflux disease. Seven cases (50%) had symptoms of snoring and/or swallowing dysfunction and/or stridor in infancy. Twelve patients had adenotonsillar surgery. In eight cases symptoms resolved completely with adenotonsillar surgery only. In total, six patients had a supraglottoplasty. There were three failures to supraglottoplasty. Conclusion: The prevalence of laryngomalacia within children presenting with SDB is 3.9%. Our findings support full evaluation of the airway to identify the site of pathology mediating SDB symptoms. Laryngoscope, 2010 [source] Case cancellations on the day of surgery: an investigation in an Australian paediatric hospitalANZ JOURNAL OF SURGERY, Issue 9 2009Victoria Haana Abstract Background:, This study investigates case cancellations on the intended day of surgery (DOS) at a paediatric hospital in Melbourne, Australia. The hospital in Melbourne treats over 32 000 inpatients annually and handles both elective and emergency cases. Methods:, The data for this paper were collected over a period of 12 months, from June 2004 to June 2005. The data were extracted retrospectively from the theatre computer system. A nurse researcher reviewed the full written details of all cancellations to clarify their cause and confirm the reasons for cancellation; the reasons for cancellation were then sorted into one of 14 groups. Results:, There were 16 559 theatre bookings, and of these, 1198 (7.2%) were cancelled on the DOS. There was a mean of 3.28 cancellations of surgery on the intended day. The hospital-initiated postponements accounted for 18.5% of DOS cancellations. The top four reasons for cancellation accounted for 65% of all cancelled surgeries and were all patient initiated. Conclusions:, There was also evidence that some specialties were more susceptible to DOS cancellation than others. The paper ends with proposals to reduce patient-initiated cancellations and directions for future research. [source] Drug allergy claims in children: from self-reporting to confirmed diagnosisCLINICAL & EXPERIMENTAL ALLERGY, Issue 1 2008E. Rebelo Gomes Summary Background Poorly documented self-reported drug allergy (DAll) is a frequent problem in daily clinical practice and has a considerable impact on prescription choices. The diagnostic work-up of drug hypersensitivity (DHs) allows a better classification of the reactions and provides patients with more reliable information and recommendations for future treatments. Objective To assess the prevalence of self-reported adverse drug reactions (ADRs) and DAll in a paediatric population and to investigate children reporting suspected DAll in order to achieve a firm diagnosis. Design The first phase was based on a cross-sectional survey assessing the life occurrence of ADRs and self-reported DAll carried out at the outpatient clinic of a paediatric hospital. The second phase was based on the diagnostic work-up in children with parent-reported DAll, including detailed anamnesis and in vitro and in vivo investigations (skin and provocation tests). Participants One thousand four hundred and twenty-six parents responded to the initial survey. Sixty of the 67 patients with reported DAll were evaluated at the allergy clinic. Results The prevalences of self-reported ADRs and DAll were 10.2% and 6.0%, respectively. Most of the suspected allergic reactions were non-immediate cutaneous events attributable to ,-lactam antibiotics and occurred in very young children. Thirty-nine of the 60 patients consulting for evaluation had a plausible clinical history and were recommended further investigation. DHs was diagnosed in three children only, based on positive responses in skin (n=1) and oral provocation (n=2) tests. Conclusion ADRs are frequently reported in children, and many children are classified as having a DAll. After complete evaluation, only a few of these reactions can be attributed to DHs and DAll. Most of the patients (94% in this study) could actually tolerate the initially suspected drug. [source] Providing support to siblings of hospitalised childrenJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2010Amanda S Newton Abstract The purpose of this study was to describe child life services provided to siblings of hospitalised children and the resources associated with these services in major paediatric hospitals throughout the United States (U.S.) and Canada. Cross-sectional data on sibling support services and resources needed for capacity building were collected via a web-based survey from administrative and clinical practice leads in identified Child Life Departments. The 34-item survey targeted three domains: Facility Demography, Sibling Support Resources, and Capacity Building and Funding. Surveys were sent to 217 leads and 109 responded (50% response rate). Of the 109 respondents, 48% indicated their facilities provided sibling support including grief or palliative support (90% of facilities) and therapeutic play (94% of facilities). More than 50% indicated that these services were not evaluated for improved family or sibling outcomes. Twenty-six percent of the respondents indicated having monies earmarked for sibling support from the following sources: hospital budget (34%), private donation (25%), foundation (22%), other (14%) and government (4%). There was a significant relationship between respondents who indicated sibling support services and funding (,2= 0.0001). Resources identified included staff availability and funding as needed for sibling support capacity building. Given the limited sibling support available in major paediatric hospitals across the U.S. and Canada, hospitals with existing resources should act as exemplars and evaluate the impact of their services with clear dissemination to other facilities. In addition to defining service effectiveness, this evaluation can help to determine the most fiscally responsible ways to deliver sibling support in their established facilities and others. [source] Transition in chronic illness: Who is going where?JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2008Katharine S Steinbeck Aim: With increasing survival rates for chronic childhood illness, there has been an increasing focus on the transition of clinical care from paediatric to adult services. Data regarding patient numbers are essential for strategic planning and for optimal management. We report on a data collection exercise from the New South Wales Greater Metropolitan Clinical Taskforce Transition Program. Methods: Data were collected between August 2004 and October 2005 through face-to-face interviews with over 200 clinicians in 68 clinical services in tertiary paediatric hospitals in New South Wales, providing information on approximately 4200 patients. Results: Sixty-eight services kept a database on patients with chronic illness but less than half were electronic. Eight services (12%) could specifically identify patients in the active phase of transition on their databases. The five most prevalent clinical groups requiring transition to adult specialist health care (excluding cerebral palsy and developmental disability) were diabetes, other endocrinology, neurology, spina bifida and gastroenterology. Conclusions: There are large numbers of young people with chronic illness and disability who need effective transition to long-term adult care. This study has enabled the identification of paediatric aspects of the transition process that require attention. [source] Physician attitudes towards ventilatory support for spinal muscular atrophy type 1 in AustralasiaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 12 2007Nimeshan Geevasinga Background: Without ventilatory support, premature death from respiratory insufficiency is virtually universal in infants with spinal muscular atrophy type 1 (SMA1). With mechanical ventilation, however, long-term survival has been reported from numerous international centres. We aimed to characterize physician attitudes to the various forms of ventilatory support for children with SMA1. Methods: We surveyed neurologists, respiratory physicians, clinical geneticists and intensivists from all major paediatric hospitals in Australia and New Zealand regarding their views on ventilatory management of SMA1. Results: Ninety-two of the 157 (59%) physicians surveyed replied. Respondents included 16 clinical geneticists, 19 intensive care physicians, 28 neurologists and 29 respiratory physicians. Almost half (47%) opposed invasive ventilation of children with SMA1 and respiratory failure precipitated by intercurrent illness. The majority (76%) opposed invasive ventilatory support for chronic respiratory failure in SMA1. In contrast, non-invasive ventilation was felt by 85% to be appropriate for acute respiratory deteriorations, with 49% supporting long-term non-invasive ventilatory support. Most physicians felt that decisions regarding ventilation should be made jointly by parents and doctors, and that hospital Clinical Ethics Committees should be involved in the event of discordant opinion regarding further management. A majority felt that a defined hospital policy would be valuable in guiding management of SMA1. Conclusions: Respiratory support in SMA1 is an important issue with significant ethical, financial and resource management implications. Most physicians in Australian and New Zealand oppose invasive ventilatory support for chronic respiratory failure in SMA1. Non-invasive ventilation is an accepted intervention for acute respiratory decompensation and may have a role in the long-term management of SMA1. Clinical Ethics Committees and institutional policies have a place in guiding physicians and parents in the management of children with SMA1. [source] The outcomes of pregnancies following a prenatal diagnosis of fetal exomphalos in Western AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Nick CALVERT Aims: To review the perinatal outcomes for prenatally diagnosed exomphalos from a single geographical region. Methods: Retrospective review of cases of prenatally identified exomphalos in the state of Western Australia in the ten-year period 1998,2007 using the medical databases of the sole tertiary obstetric and paediatric hospitals. Results: Ninety-four cases of prenatally identified exomphalos comprise this consecutive case series. Culture-proven karyotypic abnormalities occurred in 40 (42.6%) fetuses. No karyotypically abnormal fetus survived the neonatal period, with 33 of 40 (82.5%) pregnancies interrupted, five of 40 (12.5%) resulting in fetal demise and two (5%) neonatal deaths. For the 49 (52.1%) fetuses with a normal karyotype, 26 (53.1%) had associated abnormalities with termination occurring in 22 (84.6%). Prenatally isolated exomphalos was present in 23 cases (24.5%), with live birth in 15 cases (30.6% of euploid fetuses). Fourteen (93.3%) of the liveborn prenatally isolated exomphalos cases survived with no postoperative deaths, although four (28.5%) had significant abnormalities detected postdelivery and most have experienced childhood morbidity. Conclusions: In the the majority of cases of prenatally detected exomphalos the pregnancy was interrupted secondary to chromosomal or structural abnormalities. In only 10.6% of prenatally recognised fetuses with exomphalos was the disorder truly isolated with neonatal survival occurring. [source] Serotypes and antimicrobial susceptibilities of 1033 pneumococci isolated from children in Greece during 2001,2004CLINICAL MICROBIOLOGY AND INFECTION, Issue 5 2006I. Paraskakis Abstract Pneumococci (n = 1033) isolated in the major paediatric hospitals of Athens during 2001,2004 from children with invasive infections (n = 186), non-invasive infections (n = 641) and healthy carriers (n = 206) were studied. The most prevalent serotypes were serotypes 14 (44.6%), 19F (43.5%) and 6B (22.8%) in invasive, non-invasive and carriage isolates, respectively. Among invasive isolates, the potential coverage by the seven-valent conjugate vaccine was 75.3%. Resistance rates to penicillin, amoxycillin, cefotaxime, erythromycin, co-trimoxazole, clindamycin, tetracycline and chloramphenicol were 44.6%, 2.7%, 1.2%, 43.6%, 43.5%, 12.4%, 34.7% and 5.9%, respectively. The M-phenotype accounted for 68.0% of the erythromycin-resistant isolates. All isolates were susceptible to ofloxacin. 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