scholarly journals 13 Evaluating Potential Overuse of Intravenous Hydration in Patients Hospitalized with Bronchiolitis

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e5-e5
Author(s):  
Vénitia Langlois ◽  
Chloé Sainte-Marie-Lestage ◽  
Anne-Claude Bernard-Bonnin ◽  
Nathalie Lucas ◽  
Pascal Bédard ◽  
...  
Keyword(s):  
Management Practice ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Local Order ◽  
First Year ◽  
National Guidelines ◽  
Oral Hydration ◽  
Intravenous Hydration ◽  
First Year Of Life ◽  
Local Guideline

Abstract Background Bronchiolitis is the primary cause of hospitalization in children during the first year of life. Respiratory support and hydration are the two pillars of management. Practice guidelines for bronchiolitis (NICE and CPS) recommend nasogastric (NG) hydration before intravenous (IV) fluids if oral hydration cannot be maintained. However, IV hydration remains the primary mode of hydration at our tertiary care pediatric centre. Objectives This is a resource stewardship project aiming to evaluate the baseline use of IV versus NG hydration in children 0-15 months hospitalized for bronchiolitis and requiring supplemental hydration. The secondary objective is to evaluate potential barriers to NG hydration for these children. Design/Methods Data was collected retrospectively for the 2017-2018 bronchiolitis season. A survey was sent to all the pediatric emergency (ED) physicians and nurses, pediatric hospitalists, ED fellows, pediatric residents and ward nurses. Results Among eligible patients (n=95), IV hydration was prescribed 52% of the time, compared to 48% NG hydration. Ninety-six percent (47/49) of IV hydration was initiated in the ED, while only 4% (2/49) was initiated on the ward. Among patients who began receiving hydration in the ED (80/95, or 84%), 41% (33/80) were hydrated via NG and 59% (47/80) by IV. In the survey, while 92% (57/62) of responding physicians claimed to be aware of national guidelines for bronchiolitis, only 67% (42/62) said that NG was the recommended mode of hydration. Among ED practitioners, 56% (19/34) were up-to-date on the recommendation. Two-thirds of all respondents (physicians and nurses) felt that NG hydration would be more acceptable to parents. Among nurses, 84% (38/45) felt that IV installation was a longer procedure to complete. Despite the existence of a local order set indicating NG hydration as the preferred hydration method, only 64% (40/62) of physicians were aware of its existence, and only 23% of these (9/40) actually use the guideline. Main reasons of disuse included forgetting the guideline exists and it not being easily available. In contrast, 93% of nurses were aware of the local guideline. Conclusion Intravenous hydration is overused among patients hospitalized with bronchiolitis at our centre, and the ED is the main setting where this occurs. There is a discrepancy between physicians’ theoretical knowledge of hydration guidelines and the application of these in reality. Barriers to the use of NG hydration can be amenable to a quality improvement (QI) intervention targeting improved knowledge and use of our local guideline, and this will be our focus going forward.

scholarly journals Do Extremely Low Birthweight Infants Get Enough Iron in the First Year of Life Compared to Term Born Controls? - An Evaluation of Current Management Practice

1999 ◽  
Vol 45 (4, Part 2 of 2) ◽  
pp. 259A-259A
Author(s):  
Michael F Whitfield ◽  
Louis D Wadsworth ◽  
Timothy F Oberlander ◽  
Sheila M Innis ◽  
Colleen E Fitzgerald
Keyword(s):  
Low Birthweight ◽  
Management Practice ◽  
First Year ◽  
Current Management ◽  
First Year Of Life ◽  
Extremely Low Birthweight

Atopic Dermatitis

1994 ◽  
Vol 15 (8) ◽  
pp. 327-332
Author(s):  
Candace S. Lapidus ◽  
Paul J. Honig
Keyword(s):  
Atopic Dermatitis ◽  
Los Angeles ◽  
Urban Areas ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
First Year ◽  
Pediatric Dermatology ◽  
Low Humidity ◽  
First Year Of Life ◽  
Do So

Introduction Atopic dermatitis, also referred to as atopic eczema, infantile eczema, allergic eczema, disseminated neurodermatitis, and prurigo Besnier, is a common and important cause of morbidity in children of all ages. A total of 22% of patients seen in pediatric dermatology clinics have atopic dermatitis. In 1969, Wingert et al reported that 4% of pediatric emergency room visits at the Los Angeles County General Hospital were due to atopic dermatitis, and this did not include patients seen for impetigo, a common complication of atopic dermatitis. The prevalence of atopic dermatitis in the pediatric population has increased over the past 3 decades from 3% to 10%, and it appears to be even higher in heavily populated urban areas. Pediatricians, therefore, must understand its pathogenesis and management. Epidemiology Sixty percent of children who have atopic dermatitis manifest their disease in the first year of life; 90% do so by age 5 years. A genetically prone individual may not manifest the disease until exposed to a particular environmental situation. Onset has been associated with relocation from a rural to an urban location or from a region of high to low humidity. The course of adopic dermatitis is difficult to predict, although one 15-year longitudinal study revealed that the disease persisted in 60% of cases.

Clinical Characteristics of Measles in Infancy: A Hospital Based Study

2021 ◽  
Vol 36 (1) ◽  
pp. 20-24
Author(s):  
Farhana Rahat ◽  
MF Abiduzzaman ◽  
Ahmed Murtaza Choudhury
Keyword(s):  
Clinical Characteristics ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Maculopapular Rash ◽  
First Year ◽  
Runny Nose ◽  
Number Of Children ◽  
Control And Prevention ◽  
First Year Of Life ◽  
Main Complication

Background: There is a global resurgence of measles among children in recent years and a number of infants are being affected. Objectives: The aim of the study was to determine the frequency of measles in infancy and to describe their clinical characteristics in a tertiary care children hospital. Methods: A prospective observational study was conducted in Dr. MR Khan Shishu Hospital and Institute of Child Health from March, 2019 to February, 2020. The children who came with signs and symptoms of measles, like fever with maculopapular rash associated with cough, runny nose and conjunctivitis were recorded and frequency of measles in infants among hospitalized measles patients was noted. Infants with measles were enrolled for the study and their clinical characteristics, complications and outcome were determined. Data were analyzed by SPSS version 23. Results: A total of 64 infants were studied. The frequency of measles in infants among hospitalized measles patients was 43%. Forty seven percent infants were between 9 to 10 months. Clinical features were typical and all had fever and maculopapular rash. Pneumonia was the main complication and occurred in 50(78%) cases which was followed by oral ulcer 42(66%), diarrhea 26(41%), febrile seizure 9(14%) and croup 5(8%). Thirty four (53%) infant had normal nutritional status. Only 19.51% infant received first dose of measles vaccine. The mortality rate was 2(3%). Conclusion: A number of children are being affected by measles before completing first year of life and they develop complications which are related to morbidity and mortality. So, control and prevention of measles in infancy should give more importance. DS (Child) H J 2020; 36(1) : 20-24

Who needs prenatal counselling with a pediatric surgeon? Experience from a large tertiary care university hospital

2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Alizée Froeliger ◽  
Luke Harper ◽  
Sara Tunon de Lara ◽  
Frédéric Lavrand ◽  
Maya Loot ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Fetal Mri ◽  
University Hospital ◽  
First Year ◽  
Pediatric Surgeon ◽  
Prenatal Consultation ◽  
Prenatal Counselling ◽  
Large Tertiary Care ◽  
Surgeon Experience ◽  
First Year Of Life

Abstract Objectives To describe our experience with prenatal counselling for surgical anomalies in a large volume center. The secondary aim is to suggest a list of prenatal abnormalities warranting counselling by a pediatric surgeon. Methods We reviewed all prenatal counselling consultations performed by the pediatric surgery team between January 1st, 2015 and December 31st, 2016. Results A total of 169 patients or couples had a prenatal consultation with a pediatric surgeon. Prenatal work-up included a fetal MRI in 26% of cases, mainly for digestive and thoracic pathologies (56.1% of cases). Consultation with the pediatric surgeon led mainly to recommendations concerning the place of delivery. Induction for reasons related to the fetal anomaly occurred in 22.2% of cases. Most children were surgically treated within the first year of life (63.5%). Correlation between predicted prognosis and actual status at four years of life was 96.9%. Correlation between prenatal and postnatal diagnosis was 87.4%. Conclusions Prenatal counselling by a pediatric surgeon allows couples to obtain clear information on the pathology of their unborn child, giving them greater autonomy in their decision to continue the pregnancy.

Tracheotomy in the Preschool Population: Indications and Outcomes

2007 ◽  
Vol 137 (2) ◽  
pp. 280-283 ◽  
Author(s):  
Lesley C. French ◽  
Christopher T. Wootten ◽  
Robert G. Thomas ◽  
Wallace W. Neblett ◽  
Jay A. Werkhaven ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Direct Result ◽  
First Year ◽  
Care Hospital ◽  
Age Group ◽  
First Year Of Life

OBJECTIVE: Although more tracheotomy procedures are performed within the first year of life than in any other age group, preschool-aged children requiring tracheotomy remain understudied. We characterize the indications and outcomes for patients between the ages of 3 and 6 years undergoing tracheotomy. METHODS: Out of 480 pediatric tracheotomy procedures performed at a tertiary-care hospital between 1988 and 2004, 15 patients underwent primary tracheotomy between 3 and 6 years of age. RESULTS: Most (60%) procedures were performed for pulmonary toilet. Upper-airway obstruction represented the second most common indication (40%), and trauma necessitated tracheotomy procedures more often than had been predicted (40%). The decannulation rate was 40%; 2 patients died. CONCLUSION: Trauma contributed to both upper-airway obstruction as well as requirements for pulmonary toilet. These procedures performed secondary to trauma will likely continue to increase. SIGNIFICANCE: Tracheotomy procedures in the preschool population remain uncommon; however, nearly half of those studied were performed as a direct result of otherwise preventable trauma.

Clinical Management Considerations in Long-Term Survivors With Trisomy 18

PEDIATRICS ◽  
1990 ◽  
Vol 85 (5) ◽  
pp. 753-759
Author(s):  
Don C. Van Dyke ◽  
Malinda Allen
Keyword(s):  
Tertiary Care ◽  
Trisomy 18 ◽  
First Year ◽  
Chromosomal Anomalies ◽  
Medical Problems ◽  
Number Of Children ◽  
Support Organization ◽  
Present Complex ◽  
First Year Of Life ◽  
Long Term Survivors

As many as 90% or more of children with trisomy 18 die within the first year of life. A review of six patients with trisomy 18 documented by karyotype surviving past 1 year of age and of the trisomy 18 files of the Support Organization for Trisomy 18 and 13 indicated that a small number of children with trisomy 18 survive beyond their first year of life; a few live into their teens and twenties. In addition to medical problems that are unique to this chromosomal syndrome, these patients present complex medical problems common to all persons with chromosomal anomalies. The primary and tertiary care consultants who are able to provide knowledge and sensitive supportive care to children with trisomy 18 and to their parents are performing a service of significant benefit, no matter how brief the life span of the child may be.

scholarly journals The use of rapamycin to treat vascular tumours and malformations: A single-centre experience

2019 ◽  
Author(s):  
Soumitra Tole ◽  
Michelle Fantauzzi ◽  
Diana Cottingham ◽  
Joao G Amaral ◽  
Philip R John ◽  
...  
Keyword(s):  
Clinical Response ◽  
Vascular Malformations ◽  
Tertiary Care ◽  
Lesion Size ◽  
Response To Therapy ◽  
Symptom Improvement ◽  
First Year ◽  
Large Tertiary Care ◽  
Patient Reported ◽  
First Year Of Life

Abstract Objectives To assess the safety and efficacy of rapamycin in treating children with vascular tumours and malformations. Study design We performed a retrospective review at a large tertiary care paediatric centre to assess the efficacy and safety of using rapamycin to treat vascular tumours and malformations. Response to therapy was defined by patient-reported symptom improvement, radiological reduction in size of lesions, and/or improvement of laboratory parameters. Results Forty-two patients (7 with vascular tumours and 35 with vascular malformations) have been treated with rapamycin. Despite 33 of 42 patients being diagnosed in the first year of life, the median age of initiating rapamycin was 11 years. Of the 38 children treated for a minimum of 4 months, 29 (76%) exhibited a clinical response. Twenty-one patients had follow-up imaging studies and of these, 16 (76%) had radiographic decrease in lesion size. Median time to demonstration of response was 49 days. All five children with vascular tumours and all three children with vascular malformations under the age of 4 years showed a clinical response. Response rate was lower for children ≥ 4 years of age (0/2, 0% for vascular tumours; 21/28, 75% for vascular malformations). No patient experienced an infection directly related to rapamycin or discontinued rapamycin due to toxicity. Conclusions Rapamycin is safe and efficacious in most children with select vascular tumours and malformations. Young children appear to respond better, suggesting that early initiation of rapamycin should be considered.

scholarly journals Profile of congenital cataract in the first year of life from a tertiary care center in South India – A modern series

2021 ◽  
Vol 69 (4) ◽  
pp. 932
Author(s):  
Ramesh Kekunnaya ◽  
VivekMahendrapratap Singh ◽  
Akshay Badakere ◽  
Preeti Patil-Chhablani
Keyword(s):  
Congenital Cataract ◽  
South India ◽  
Care Center ◽  
Tertiary Care ◽  
First Year ◽  
Tertiary Care Center ◽  
First Year Of Life

scholarly journals Evaluation of care for at-risk newborns from the perspective of a public health policy

2011 ◽  
Vol 19 (2) ◽  
pp. 293-300 ◽  
Author(s):  
Ana Lúcia Forti Luque ◽  
Célia Mara Garcia de Lima ◽  
Maria Antonieta de Barros Leite Carvalhaes ◽  
Vera Lúcia Pamplona Tonete ◽  
Cristina Maria Garcia de Lima Parada
Keyword(s):  
Public Health ◽  
At Risk ◽  
Evaluation Study ◽  
Population Based ◽  
Public Health Care ◽  
First Year ◽  
National Guidelines ◽  
Health Care Policies ◽  
First Year Of Life

The aim was to evaluate the care for at-risk newborns under follow-up in their first year of life by the Growing Happily Program, developed in a city in inner São Paulo state. It is a population-based epidemiological health program evaluation study, which was based on the national guidelines of the Agenda of Commitments to Children and Child Mortality Reduction for data analysis. Results showed the program’s institutional vulnerability, caused by problems related to its structure and process, with implications for its outcomes. Considering the adaptation of the criteria adopted by the Program for defining at-risk newborns, as well as the proposed interventions and strategies, in consonance with the Agenda of Commitments, the need for managers to make it a priority is appointed, by effectively including it in public health care policies to be developed in cities, in order to reverse the institutional vulnerability identified.

The Development of Swallowing Respiratory Coordination

2009 ◽  
Vol 18 (1) ◽  
pp. 19-24
Author(s):  
Maggie-Lee Huckabee
Keyword(s):  
Cortical Activation ◽  
First Year ◽  
Healthy Children ◽  
Nasal Airflow ◽  
Single Session ◽  
Primary Finding ◽  
Patterns Of Behavior ◽  
Cortical Modulation ◽  
First Year Of Life ◽  
Swallowing Apnea

Abstract Research exists that evaluates the mechanics of swallowing respiratory coordination in healthy children and adults as well and individuals with swallowing impairment. The research program summarized in this article represents a systematic examination of swallowing respiratory coordination across the lifespan as a means of behaviorally investigating mechanisms of cortical modulation. Using time-locked recordings of submental surface electromyography, nasal airflow, and thyroid acoustics, three conditions of swallowing were evaluated in 20 adults in a single session and 10 infants in 10 sessions across the first year of life. The three swallowing conditions were selected to represent a continuum of volitional through nonvolitional swallowing control on the basis of a decreasing level of cortical activation. Our primary finding is that, across the lifespan, brainstem control strongly dictates the duration of swallowing apnea and is heavily involved in organizing the integration of swallowing and respiration, even in very early infancy. However, there is evidence that cortical modulation increases across the first 12 months of life to approximate more adult-like patterns of behavior. This modulation influences primarily conditions of volitional swallowing; sleep and naïve swallows appear to not be easily adapted by cortical regulation. Thus, it is attention, not arousal that engages cortical mechanisms.

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