Exploring factors influencing patient mortality and loss to follow-up in two paediatric hospital wards in Zamfara, North-West Nigeria, 2016–2018

Introduction Child mortality has been linked to infectious diseases, malnutrition and lack of access to essential health services. We investigated possible predictors for death and patients lost to follow up (LTFU) for paediatric patients at the inpatient department (IPD) and inpatient therapeutic feeding centre (ITFC) of the Anka General Hospital (AGH), Zamfara State, Nigeria, to inform best practices at the hospital. Methods We conducted a retrospective cohort review study using routinely collected data of all patient admissions to the IPD and ITFC with known hospital exit status between 2016 and 2018. Unadjusted and adjusted rate ratios (aRR) and respective 95% confidence intervals (95% CI) were calculated using Poisson regression to estimate the association between the exposure variables and mortality as well as LTFU. Results The mortality rate in IPD was 22% lower in 2018 compared to 2016 (aRR 0.78; 95% CI 0.66–0.93) and 70% lower for patients coming from lead-affected villages compared to patients from other villages (aRR 0.30; 95% CI 0.19–0.48). The mortality rate for ITFC patients was 41% higher during rainy season (aRR 1.41; 95% CI 1.2–1.6). LTFU rates in ITFC increased in 2017 and 2018 when compared to 2016 (aRR 1.6; 95% CI 1.2–2.0 and aRR 1.4; 95% CI 1.1–1.8) and patients in ITFC had 2.5 times higher LTFU rates when coming from a lead-affected village. Conclusions Our data contributes clearer understanding of the situation in the paediatric wards in AGH in Nigeria, but identifying specific predictors for the multifaceted nature of mortality and LTFU is challenging. Mortality in paediatric patients in IPD of AGH improved during the study period, which is likely linked to better awareness of the hospital, but still remains high. Access to healthcare due to seasonal restrictions contributes to mortalities due to late presentation. Increased awareness of and easier access to healthcare, such as for patients living in lead-affected villages, which are still benefiting from an MSF lead poisoning intervention, decreases mortalities, but increases LTFU. We recommend targeted case audits and qualitative studies to better understand the role of health-seeking behaviour, and social and traditional factors in the use of formal healthcare in this part of Nigeria and potentially similar settings in other countries.

Thromboembolic Events in Critically Ill Children with Multiple Risk Factors for Venous Thrombosis

The risk for venous thromboembolism (VTE) is considered to be low in the general paediatric intensive care unit (PICU) population, and pharmacological thromboprophylaxis is not routinely used. PICU patients considered at high-risk of VTE could possibly benefit from pharmacological thromboprophylaxis, but the incidence of VTE in this group of patients is unclear. This was an observational, prospective study at a tertiary multi-disciplinary paediatric hospital. We used comprehensive ultrasonography screening for VTE in critically ill children with multiple risk factors for VTE. Patients admitted to PICU ≥72 hours and with ≥two risk factors for VTE were included. Patients receiving pharmacological thromboprophylaxis during their entire PICU stay were excluded. Since pharmacological thromboprophylaxis has not been proven effective for central venous catheter(CVC)-related VTE, the primary outcome was VTEs not related to the use of a CVC. Ultrasonography screening of the great veins was performed at PICU discharge. Seventy patients with median (interquartile range) 3 (2-4) risk factors for VTE were evaluated. Median age was 0.34 years (0.03-4.3) and median PICU length of stay 9 days (5-17). Regarding the primary outcome, no symptomatic VTEs occurred and no asymptomatic VTEs were found on ultrasonography screening. The observed proportion of VTE, 0 in 70 patients, corresponds to a VTE incidence of 0-5.1%. Conclusion: No VTEs where pharmacological thromboprophylaxis could potentially have been an effective prophylactic measure were found. This indicates that VTE is an uncommon event even in a selected group of severely ill small children considered to be at high risk of VTE.

Clinical characteristics and predictive mortality risk factors in hospitalised children with COVID-19 illness during the first and second wave: single centre experiences from a tertiary paediatric hospital in Mumbai

Background: Coronavirus disease 2019 (COVID-19) pandemic has affected both adults and children alike. It presented in cluster of cases in short period of time all across the world. In India, there were two such clusters called as first and second wave. World over mortality was more in adults than in children. But, few children also had severe disease during these waves. Also, some presented with inflammatory state secondary to COVID-19 infection which is called as Multisystem Inflammatory syndrome in children (MIS-C). As major population affected with severe disease were older people this disease in initial phases was most studied in this population. It is thus necessary to observe and analyse disease manifestations, pattern and risk factors in children and also contrast these variables between the two waves. The objectives of the study was to compare and contrast clinico-demographic parameters and outcome predictors in children admitted with COVID-19 during the first and second waves.Methods: This is a retrospective analytical study comparing aforementioned parameters of children (with and without co-morbidity) admitted with COVID-19 infection between the two waves of pandemic in a tertiary care public pediatric hospital in Western Maharashtra.Results: First wave had 176 cases admitted over six months while the second wave had 185 cases over only three months. While proportion of cases with pneumonia requiring ICU stay was significantly higher in wave 2, those with MIS-C requiring inotropes was higher in wave 1. There was no difference in other clinico-demographic parameters of these cases irrespective of co-morbidity. Pneumonia, severe disease, hypoxia, need for inotropes or ICU care predicted poor outcome in both the waves.Conclusions: Though the pattern of presentation was different, the clinico-demographic variables and predictors of mortality were comparable between the two waves.

189 A SIMULATION WITH NO PARTICIPANTS ONLY CO-FACULTY: USING SIMULATION FOR SYSTEMS INTEGRATION ON THE LARGE SCALE

The large-scale relocation of a paediatric hospital is a significant undertaking. New environments change the system, and ways of working must adapt to maintain quality healthcare. There are risks to patients and staff well-being, with high anxiety around change. There is evidence for the efficacy of simulation as a tool for safe training and rehearsal of staff and teams [1] but less so on such a large scale. Simulation for many is still perceived as a test of performance and a threat. We connected with the international simulation community to design a hospital-wide programme of Patient Environment Simulations for Systems Integration (PESSI). This paper outlines challenges in establishing buy-in from stakeholders and departments, developing a framework for implementation and our reflections on delivery of large-scale simulation activities to assist a hospital move.How can simulation-based methodology be used to support clinical departments on a large scale to adapt/integrate/prepare in moving to a brand-new hospital?Collaboration with authors of PEARLS for system integration use [1], using it as the main framework for delivery and structure of PESSI. Stages of delivery were: pre-phase work, system testing day, debrief/reflection and evaluation. Immediate feedback of enjoyment and learning was collated from all participants. Three-month post-move feedback is planned to review ongoing impact/behaviour change plus analysis of safety incidents.Pre-phase work involved meeting stakeholders and establishing aims of testing. Ward managers were key departmental links, meeting with members of PESSI to plan scenarios. System testing days involved familiarizing themselves with the environment, followed by ‘day in the life’ simulations with a representation of the whole team. All participants were called ‘co-faculty’ and knew exactly what would happen. Debrief involved facilitated conversations with the whole team describing reactions, and deeper analysis of the key events, with concerted efforts by facilitators to give a balanced approach of positives and challenges. A short report was given back to the department detailing the findings teams would need solutions to. Solutions from simulation were implemented prior to the move, increasing staff confidence, with many feeling PESSI played a major role in feeling prepared for the new site. The PESSI framework is being utilized in adult services and we hope to publish our methodology to share with the wider simulation community.

Case Series of Variable Acute Appendicitis in Children with SARS-CoV-2 Infection

This case series study consists of six children, aged 5–16 years, admitted to a centralized tertiary paediatric hospital serving a population of 1.9 million with acute appendicitis in the setting of SARS-CoV-2 infection. From the beginning of the pandemic in March 2020 until August 2021, 121 COVID-19-positive children were admitted to the hospital. A total of 49 (40.5%) of these patients presented with gastrointestinal symptoms, of which six were diagnosed with acute appendicitis. Five underwent an appendectomy, while one was treated conservatively. To date, it has been reported that appendicitis may have a plausible association with SARS-CoV-2 infection in children. With COVID-19 cases rising, every medical specialist, including all paediatric surgeons, must be ready to treat common acute diseases with SARS-CoV-2 infection as a comorbidity. Providers should consider testing for this infection in paediatric patients with severe gastrointestinal symptoms. Non-surgical treatment of acute appendicitis in children may gain new importance during and after the COVID-19 pandemic. Further studies are needed to prove the link of causality between COVID-19 and acute appendicitis in children.

The Role of Music Therapy for Children Undergoing Cancer Treatment in Singapore

The aim of this study was to explore the benefits of music therapy (MT) for children with cancer over the course of their treatment in an acute paediatric hospital setting in Singapore. Twenty-five children undergoing cancer treatment received MT sessions as part of a multidisciplinary team rehabilitation intervention from March 2017 to January 2020. A total of 37 individualised goals were developed by the music therapist for each child. Goals were scored via the Goal Attainment Scale at 3-month intervals up to 1 year. Descriptive statistics and correlation analysis were used to evaluate the findings. The rate of goal achievement was 89.2% over 180 MT sessions (M = 7.20, SD = 6.45). Children diagnosed with brain tumours had the highest frequency of music sessions (M = 9.11, SD = 7.79). Most of the goals targeted the regulation of mood and morale through music. There was a positive correlation found between goals and sessions (rs = 0.56, p = 0.004). Age of the children was not correlated with the number of sessions received (rs= −0.19, p = 0.354). MT has been found to be an accessible and effective intervention in addressing functional and emotional goals for children across all ages who are undergoing cancer treatment.

Pattern and Outcome of Paediatric Surgeries: A Private Paediatric Hospital Experience in Southern Nigeria

Aim: This study was undertaken to determine the pattern and outcome of paediatric surgeries in a private hospital in Southern Nigeria. Study Design: A retrospective study Place and Duration of Study: Study was carried out at a private paediatric hospital over a 14-months period from 1st April 2020–31st May 2021. Methodology: Essential information needed were retrieved from the hospital Health Management System and data analysed using SPSS version 23. Results: Of 1289 children admitted during the study period, 105 had surgical interventions (prevalence of 8.1%). Age range was from 8 days to 16 years (median age of 36months) with male predominance. Only 34.3% of the patients were self-paying. The most common surgical conditions were congenital anomalies (28.1%), followed by surgical infections (22.8%) and then urogenital diseases (19.3%). The least common were central nervous system diseases (0.9%). Emergencies accounted for 39.8% of cases done. The commonest surgeries done were circumcision (16.8%), appendicectomy (15.9%) and herniotomy/herniorraphy (14.2%). One child died (mortality rate of 1%). Duration of stay was mostly < 3days (41.7%). Longest duration was seen in those who had Laparotomy and Skin graft. Conclusion: The prevalence of surgical interventions in a paediatric private hospital in Southern Nigeria was high with emergency surgeries constituting 38.9% of all cases. Thus, for reduction in paediatric morbidity and mortality, we advocate the improvement of surgical infrastructure and manpower not only in tertiary but also in the private health sector.

THE CLINICAL PROFILE OF DENGUE PATIENTS IN CHILDREN

Background: To study the clinical profile of dengue in children Methods: The hospital based study was conducted on patients presenting to paediatric hospital, who fulfilled inclusion and exclusion criteria. Results: Based on the symptoms, the most common symptoms noticed were fever 94.00% followed by myalgia 85.00% decreased appetite 83%, retroorbital pain in 84.0% and vomiting 81.00% Conclusion: It concluded that common symptoms observed were fever, myalgia, decreased appetite and headache The common complications presented were hepatic dysfunction and shock with no mortality indicating the presence of less virulent organisms.. Keywords: Dengue, Complication, Shock