Paediatrics

Evaluating the lasting effects of teaching sudden unexpected death in infancy and childhood (SUDIC) through simulation (2023)

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Type of publication:Conference abstract

Author(s):Layman S.; Beatty C.; Williams C.; *Belfitt A.; Copeman A.

Citation:Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2023. Glasgow United Kingdom. 108(Supplement 2) (pp A276-A277), 2023. Date of Publication: July 2023.

Abstract:Objectives Paediatricians play a vital role in managing and facilitating investigations in sudden unexpected death in infancy or childhood (SUDIC). SUDIC is a rare occurrence, and many paediatric trainees and consultants have very little experience of the process. The SUDIC simulation course was created due to recommendations by The Kennedy Report. The aim of the course was to bridge the gap between knowledge and clinical experience for senior paediatric trainees and consultants in the West Midlands in managing SUDIC. To assess the longevity of learning from the course, a survey was disseminated to all previous candidates. Its aim was to understand how important the simulation course had been in improving paediatricians' confidence and understanding of the SUDIC process when they were involved in a SUDIC after attending the course. Methods Candidate sign-in sheets were retrospectively reviewed for the 17 SUDIC courses run since January 2016. 195 previous candidates were invited to complete a survey via email. Our aim was to evaluate how the course had impacted subsequent experience of the SUDIC process. Specific questions were included to assess how confident candidates had been in various roles in the SUDIC process using a combination of multiple-choice, free-text, and Likert scales. Results 43% of respondents had been a senior paediatric registrar when they attended. Other candidates were consultants, nurses, or more junior paediatricians. 43% had attended between 1-5 SUDIC events since the course, with 4% having attended more than 10. 47% had been involved in examining the body. 40% involved in an unsuccessful resuscitation and SUDIC investigations, and 43% explained the SUDIC process to bereaved parents. 100% agreed that the course had improved their confidence in explaining the SUDIC process, taking a SUDIC history and performing SUDIC investigations. 94% felt confident in contributing to the child death process with 89% feeling confident in examining the body. Candidates particularly valued the multi-professional approach to the course, especially working with police officers. With further thematic analysis of free text responses, candidates most often reported lasting benefits to supporting and communicating with the family, and understanding the practicalities of the SUDIC process. Conclusion Participation in a SUDIC simulation course is an important educational experience, which continues to be relevant to participants and their clinical practice many years after they have attended. Our survey suggests that simulation-based education is an excellent modality to facilitate learning around the SUDIC process for paediatricians and other health professionals involved.

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Improved efficiency and safety ED Paediatric Storeroom (2022)

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Type of publication:
Service improvement case study

Author(s):
*Abi Kelly (Sister) and *Pauline Roberts (Housekeeper)

Citation:
SaTH Improvement Hub, September 2022

Abstract:
The ED Paediatric is a new facility and the storeroom is small and requires 5s intervention as the storeroom is often cluttered, making it difficult to maintain IPC standards, while at the same time, maintaining a safe working environment. To be successful, it will be necessary to involve EDC operators, HCAs, Nursing Staff and Housekeepers.

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Improve completion of Fluid and Solid balance charts in Paediatrics PRH (2023)

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Type of publication:
Service improvement case study

Author(s):
*Aisha Noor (FY1) *Farhah Anuar (FY1)

Citation:
SaTH Improvement Hub, March 2023

Abstract:
To improve completion of Fluid balance charts for Paediatric patients at PRH by 30% by 06th May 2023.

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All sleep and no play? An audit and service evaluation of children undergoing radiological imaging (2022)

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Type of publication:
Conference abstract

Author(s):
*Muneer K.

Citation:
Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2022. Liverpool United Kingdom. 107(Supplement 2) (pp A120-A121), 2022. Date of Publication: August 2022.

Abstract:
Aims The use of sedation in children for radiological imaging is common practice in Paediatrics. However, the risks need to be weighed against the benefits of imaging under sedation. Play therapy has been considered as an alternative to sedation in a cooperative child. This study explored the safety, efficacy and adherence of practice to local trust guidelines for sedation of children (derived from the NICE Sedation under 19s guidelines) and highlighted play therapy as a potential alternative for selected children requiring radiological imaging. Methods Data was gathered retrospectively from a 6 month period with the help of the Trust's medical records department. There were 36 children who underwent sedation for various imaging modalities and 19 children who had imaging done utilising play therapy over the same period. The information gathered from the resources used was collated in an excel database for the purpose of comparative analysis. Results 1. The assignment of patients was based on their clinical presentation, urgency and medical background 2. Children receiving sedation were predominantly below the age of 3 years while those in the play group were between 6-9 years 3. The youngest child to receive sedation was 3 months old and the youngest to have successful MRI using play therapy was 3 years 5 months 4. The success rate of Sedation was 92% vs. 86% for play therapy 5. 83% underwent MRI, 11% DMSA and 6% MAG3 under sedation. 95% had MRI and 5% CT in the play group 6. 14% required a repeat dose of medication for sedation 7. None had complications secondary to sedation 8. One had MRI Head done under sedation and later MRI Spine successfully under play therapy at 3 years 5 months 9. Where all documents were available for analysis, the adherence to local guidelines for sedation was 100% Conclusion 1. Sedation is a safe and effective option available in a DGH setting for young children needing relatively urgent radiological imaging to establish diagnosis where the benefits generally outweigh the risks. 2. Play therapy is a suitable alternative for cooperative children who can be adequately prepared. 3.Healthcare teams and parents need to be made more aware of these options in the future.

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A Retrospective Audit Of The Management of Patients on a General Paediatric Ward With Anorexia Nervosa Against Marsipan Guidelines (2022)

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Type of publication:
Conference abstract

Author(s):
Franklin L.; *Cowley A.; *Bennett R.

Citation:
BMJ Paediatrics Open. Conference: Royal College of Paediatrics and Child Health, RCPCH and the Young Person's Health Special Interest Group, YPHSIG 2022. Birmingham United Kingdom. 6(Supplement 1) (pp A22-A23), 2022. Date of Publication: 2022.

Abstract:
Objectives The Junior MARSIPAN guidelines were created to improve the medical care of paediatric patients with severe anorexia nervosa. This audit aims to evaluate the care provided by a general paediatric ward compared to the recommendations outlined in the MARSIPAN guidelines and the completion of risk assessments. Methods Retrospective analysis of patient notes was conducted on the most recent admission to the general paediatric ward of 10 patients with anorexia nervosa within the last 24 months. The documentation of their care was audited against a pre-made proforma based on the MARSIPAN guidelines and the MARSIPAN risk assessment. Medical notes and a nursing care pathway document were reviewed. The initial blood tests, refeeding blood and nursing care was also assessed. The inclusion criteria for this audit was any patient under the age of 18-years-old admitted in the last 24 months to the general paediatric ward. Any patients currently admitted or without a complete set of admission and inpatient medical notes were excluded. Results 10 patients were included and a total of 434 bed days were assessed. Our results show variability in compliance with the MARSIPAN guidelines, in terms of the initial admission and the care received. On admission, 70% of the patients were reviewed by a consultant, 30% had a full MARSIPAN risk assessment and 40% had a percentage median BMI calculated. Important investigations were inconsistently completed, such as an ECG with a recorded QTc length (70%), sitting and standing blood pressure (20%), dehydration assessment (30%), and SUSS stand-squat and sit-up test (20%). Common initial blood tests such as Full Blood Count, Bone Profile and Liver Function Tests were completed for all patients, however many of the other important investigations were incomplete; for example Folate and B12 (40%), amylase (20%) and creatinine kinase (0%). 80% of the patients received daily biochemical blood tests to screen for refeeding syndrome in their first week in hospital; 100% of the refeeding blood tests included U&Es, magnesium, and phosphate levels. During their stay, 80% of patients had input from a dietitian and 100% had input from either CAMHS or a specialist eating disorder service. 20% of patients had daily consultant reviews and 30% of patients had a MARSIPAN risk assessment done during their admission, with only 10% having regular risk assessments. All patients received thiamine and vitamin supplementation. Nursing care was adherent to guidelines with 4-hourly vitals, enforced bed-rest, and supervised mealtimes for 100% of patients. 70% of patients had 4-hourly blood glucose measurements. Conclusions The medical care documentation assessed in this audit was not compliant with MARSIPAN guidelines but nursing care was. The findings in this audit, along with national audits, suggest sub-optimal care for inpatient admissions with anorexia nervosa. The excellent nursing results demonstrates the introduction of the nursing pathway document makes a significant difference. We recommend a joint medical and nursing pathway document for admission including weekly medical reviews should be implemented and re-audited to reassess the documentation and adherence to guidelines, especially in light of the new MEED (Medical emergencies in eating disorders -CR233) guidelines.

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Outcomes for Paediatric Patients Awaiting Bilateral Myringotomy and Ventilation Tube Insertion for Otitis Media with Effusion Listed Prior to the COVID-19 Pandemic (2022)

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Type of publication:Conference abstract

Author(s):*Lovett A.; Walters B.; Kumar Bhimrao S.

Citation:British Journal of Surgery. Conference: ASiT Surgical Conference 2022. Aberdeen United Kingdom. 109(Supplement 6) (pp vi38), 2022. Date of Publication: September 2022

Abstract:Aim: The decline in the incidence of otitis media with effusion (OME) during the COVID-19 pandemic has become apparent. This review investigates the outcomes for children with OME awaiting bilateral myringotomy and ventilation tube (BMT) who were referred prior to the COVID-19 pandemic. Method(s): All patients were reviewed in otolaryngology clinics between 1st February and 30th April 2021. Patients included were referred due to hearing, vestibular or developmental disorders prior to the first COVID-19 lockdown on 23rd March 2020. Analysis of routine consultation and audiological assessment was completed from records. Result(s): There were a total of 48 patients awaiting BMT. The average age was 6.8 years, with a male to female ratio of 1.38:1. Most initial referrals (54.2%) were due to hearing loss, followed by recurrent ear infections (33.3%). Forty-four patients were diagnosed with OME. Of those, only 9% remained awaiting BMT. All others were removed from the waiting list. One patient remained listed for an adenotonsillectomy, 30 were discharged, and nine required follow-up appointments. Conclusion(s): Our review demonstrates a significant reduction of BMT for OME following COVID-19. Further research on public health measures and changes in clinical practice during the 2020 lockdown would clarify the impact on OME.

Is pain properly managed in children presenting with fractures? A retrospective audit of children presenting to the emergency department (2020)

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Type of publication:
Conference abstract

Author(s):
*Rafie A

Citation:
British Journal of Surgery; Jun 2020; vol. 107 ; p. 68

Abstract:
Aim: Pain is a common problem in the surgical field, especially when treating children – but how well is it managed, and documented? In this audit we aim to answer a few key questions. Is analgesia administered prehospital? Are pain scores recorded, and re-evaluated? And is analgesia offered and/or administered in the Emergency Department(ED)? Method: A retrospective audit was carried out between two hospitals on 100 patients aged between 5-15 presenting to the ED. A search was carried out using SNOMEDand ICD10 codes, to find patients presenting with fractures – and the ED CAS cards reviewed.
Result(s): The data showed poor compliance between both hospitals – pain scores were seldom recorded, or reevaluated; and in 58% of cases analgesia was not offered and no reason was documented. 28% of patients were given pre-hospital analgesia and only 2% of patients had an analgesia review.
Conclusion(s): Adequate pain management is vital, especially in children – as they often don't self-report pain. The study found that the worst compliance was in documentation of pain scores, and their re-evaluation. However, more concerningly analgesia was only administered in 19% of cases – and in many cases there was no documentation as to why it wasn't offered.

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Supratentorial vs infratentorial posterior calvarial distraction osteogenesis for the increase of ICV in children with syndromic or multi-suture craniosynostosis: a retrospective cohort study (2021)

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Type of publication:
Journal article

Author(s):
Sharman J.; Rodrigues D.; McGuirk S.; *Panikkar M.; Nishikawa H.; Dover S.; Evans M.; White N.

Citation:
Child's Nervous System; 2021 [epub ahead of print]

Abstract:
Purpose: Craniosynostosis is the premature and pathological fusion of calvarial sutures. One modality of surgical treatment of syndromic craniosynostosis is posterior calvarial distraction (PCD). This can be either supratentorial or infratentorial. Currently, supratentorial PCD may be regarded as safer but produces a smaller increase in calvarial volume compared to infratentorial PCD. This study quantifies and compares the effectiveness of supratentorial and infratentorial PCD to help guide surgical decision-making. Method(s): The CT and/or MRI scans of 47 cases of craniosynostosis who underwent PCD from the Birmingham Children's Hospital (BCH) were converted to sagittal series multi-planar reformatted (MPR) scans for the manual calculation of ICV. The 47 cases were classified as having undergone either supratentorial or infratentorial PCD using lateral plain film radiographs, with 28 and 32 pairs of pre- and post-operative CT/MRI scans reviewed respectively. Result(s): A statistically significant difference between supratentorial and infratentorial PCD was observed for the increase in supratentorial volume (STV) (P = 0.0458) and total intracranial volume (TICV) (P = 0.0437), but not for the increase in infratentorial volume (ITV) (P = 0.0697). The relationship for each volume trended towards convergence but was not achieved before the physical limit of 30 mm distraction had been reached. Intraclass correlation coefficient values for agreement of MRI and CT scans for STV, ITV and total ICV were 0.852, 0.864 and 0.854 respectively. Conclusion(s): Our evidence suggests that supratentorial PCD is more effective for increasing ICV in a clinical setting. CT and MRI imaging modalities are acceptably clinically interchangeable for calculating ICV in craniosynostosis.

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Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): providing resuscitative care (2020)

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Type of publication:
Journal article

Author(s):
*Kempsell-Smith M.; *Meenan S.

Citation:
Nursing children and young people; 2020 Sep 10;32(5):13-16

Abstract:
Little is understood about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the COVID-19 pandemic. Furthermore, there is limited literature available and few case studies exploring the observations of colleagues involved in managing patients with COVID-19. Children represent a small sample of the confirmed cases of COVID-19 in the UK but the reasons for this are relatively unknown. Most children are asymptomatic or exhibit mild symptoms from COVID-19 infection. However, a small number have been identified who develop a significant systemic inflammatory response, referred to as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). PIMS-TS involvespersistent fever and organ dysfunction. PIMS-TS can also share clinical features with other conditions including toxic shock syndrome, septic shock and Kawasaki disease. This article presents a case study to explore the resuscitative care provided to a ten-year-old child with suspected PIMS-TS.

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Current management of children and young people with heterozygous familial hypercholesterolaemia - HEART UK statement of care (2019)

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Type of publication:
Journal article

Author(s):
Ramaswami U.; Humphries S.E.; Priestley-Barnham L.; Green P.; Wald D.S.; *Capps N.; Anderson M.; Dale P.; Morris A.A.

Citation:
Atherosclerosis; Nov 2019; vol. 290 ; p. 1-8 [epub ahead of print]

Abstract:
This consensus statement on the management of children and young people with heterozygous familial hypercholesterolaemia (FH) addresses management of paediatric FH in the UK, identified by cascade testing when a parent is diagnosed with FH and for those diagnosed following incidental lipid tests. Lifestyle and dietary advice appropriate for children with FH; suggested low density lipoprotein cholesterol (LDL-C) targets and the most appropriate lipid-lowering therapies to achieve these are discussed in this statement of care. Based on the population prevalence of FH as ~1/250 and the UK paediatric population, there are approximately 50,000 FH children under 18 years. Currently only about 550 of these children and young people have been identified and are under paediatric care.

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