The Waiting Room Assessment to Virtual Emergency Department pathway: Initiating video-based telemedicine in the pediatric emergency department

The COVID-19 pandemic has presented pediatric emergency departments with unique challenges, resulting in a heightened demand for adapted clinical pathways. In response to this need, the Montreal Children's Hospital pediatric emergency department introduced the WAVE (Waiting Room Assessment to Virtual Emergency Department) pathway, a video-based telemedicine pathway for selected non-critical patients, aiming to reduce safety issues related to emergency department overcrowding, while providing timely care to all children presenting and registering at our emergency department. The objective of the WAVE pilot phase was to evaluate the feasibility and acceptability of telemedicine in our pediatric emergency department, which was previously unfamiliar with this mode of care delivery. During the six-week, three-evening per week deployment, we conducted 18 five-hour telemedicine shifts. In total, 27 patients participated in the WAVE pathway. Results from this pilot phase met four of five a priori feasibility and acceptability criteria. Overall, participating families were satisfied with this novel care pathway and reported no disruptive technological barriers.

Estimation of Radiation Exposure in the Pediatric Cath Lab in Ain Shams University; Cross-Sectional Observational Study

Aim and objectives The aim of the study is to assess the average radiation doses recorded per procedure in Ain Shams University Hospital pediatric cath lab to set benchmarks of radiation exposure in our institute. Patients and Methods The study included 198 patients who presented to Ain Shams cardiac pediatric cath lab who undergone interventional (BPV, BAV, ASD device closure, VSD device closure, PDA coil/device closure, Coarctation Stent/balloon) and diagnostic (Hemodynamics study, Diagnostic cath) heart catheterization. Radiation doses were measured without any interference with the operator’s preferences. Results Radiation dosages were measured in total AirKerma, Dose area product (DAP), and fluoroscopy time to set the benchmarks for radiation exposure in our institute per procedure. VSD device closure showed the highest radiation exposure followed by Coarctation stenting. Lowest radiation dosage was in PDA coil closure followed by ASD device closure then BPV. Conclusion Benchmarks for radiation exposure per procedure in pediatric cath lab in our institute were set and compared to each other.

An observational cohort study comparing ibuprofen and oxycodone in children with fractures

Objective To compare the effectiveness and safety of prescribing ibuprofen and oxycodone for at-home management of children’s fracture pain. Methods A prospective observational cohort was conducted at the Stollery Children’s Hospital pediatric emergency department (June 2010-July 2014). Children aged 4–16 years with an isolated fracture discharged home with advice to use either ibuprofen or oxycodone were recruited. Results A cohort of 329 children (n = 217 ibuprofen, n = 112 oxycodone) were included. Mean age was 11.1 years (SD 3.5); 68% (223/329) were male. Fracture distribution included 80.5% (264/329) upper limb with 34.3% (113/329) requiring fracture reduction. The mean reduction in Faces Pain Score-Revised score (maximum pain–post-treatment pain) for Day 1 was 3.6 (SD 1.9) (ibuprofen) and 3.8 (SD 2.1) (oxycodone) (p = 0.50); Day 2 was 3.6 (SD 1.8) (ibuprofen) and 3.7 (SD 1.6) (oxycodone) (p = 0.56); Day 3 was 3.7 (SD 1.7) (ibuprofen) and 3.3 (SD 1.7) (oxycodone) (p = 0.24). Children prescribed ibuprofen (51.2%, 109/213) experienced less adverse events compared to those prescribed oxycodone (70.5% 79/112) on Day 1 (p = 0.001). Children prescribed ibuprofen (71.8%, 150/209) had their function (eat, play, school, sleep) affected less than those prescribed oxycodone (83.0%, 93/112) (p = 0.03) on Day 1. Conclusion Children prescribed ibuprofen or oxycodone experienced similar analgesic effectiveness for at-home fracture pain. Oxycodone prescribing was associated with more adverse events and negatively impacted function. Oxycodone use does not appear to confer any benefit over ibuprofen for pain relief and has a negative adverse effect profile. Ibuprofen appears to be a safe option for fracture-related pain.

Etiologic-sociodemographic assessment and comparison of dialysis modalities in pediatric Syrian migrants with chronic kidney disease

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are among the important causes of mortality and morbidity in childhood. Early diagnosis and treatment of the underlying primary disease may prevent most of CKD patients from progressing to ESRD. There is no study examining chronic kidney diseases and dialysis modalities in Syrian immigrant children. We aimed to retrospectively research the etiologic, sociodemographic, and clinical factors in CKD among Syrian refugee children, and at the same time, to compare the clinical characteristics of patients with ESRD on peritoneal dialysis and hemodialysis. Methods: Our study included a total of 79 pediatric Syrian patients aged from 2-16 years monitored at Hatay State Hospital pediatric nephrology clinic with diagnosis of various stages of CKD and with ESRD. Physical-demographic features and clinical-laboratory information were retrospectively screened. Results: The most common cause of CKD was congenital anomalies of the kidneys and urinary tracts (CAKUT) (37.9%). Other causes were urolitiasis (15.1%), nephrotic syndrome (10.1%), spina bifida (8.8%), hemolytic uremic syndrome (7.5%), and glomerulonephritis (7.5%). Twenty-five patients used hemodialysis due to bad living conditions. Only 2 of the patients with peritoneal dialysis were using automatic peritoneal dialysis (APD), with 5 using continuous ambulatory peritoneal dialysis (CAPD). Long-term complications like left ventricle hypertrophy and retinopathy were significantly higher among hemodialysis patients. There was no difference identified between the groups in terms of hypertension and sex. Conclusion: Progression to ESRD due to preventable reasons is very frequent among CKD patients. For more effective use of peritoneal dialysis in pediatric patients, the responsibility of states must be improved.

Pediatric In-Hospital Cardiac Arrest International Registry (PACHIN): protocol for a prospective international multicenter register of cardiac arrest in children

Background and aims Cardiac arrest (CA) in children is a major public health problem. Thanks to advances in cardiopulmonary resuscitation (CPR) guidelines and teaching skills, results in children have improved. However, pediatric CA has a very high mortality. In the treatment of in-hospital CA there are still multiple controversies. The objective of this study is to develop a multicenter and international registry of in-hospital pediatric cardiac arrest including the diversity of management in different clinical and social contexts. Participation in this register will enable the evaluation of the diagnosis of CA, CPR and post-resuscitation care and its influence in survival and neurological prognosis. Methods An intrahospital CA data recording protocol has been designed following the Utstein model. Database is hosted according to European legislation regarding patient data protection. It is drafted in English and Spanish. Invitation to participate has been sent to Spanish, European and Latinamerican hospitals. Variables included, asses hospital characteristics, the resuscitation team, patient’s demographics and background, CPR, post-resuscitation care, mortality, survival and long-term evolution. Survival at hospital discharge will be evaluated as a primary outcome and survival with good neurological status as a secondary outcome, analyzing the different factors involved in them. The study design is prospective, observational registry of a cohort of pediatric CA. Conclusions This study represents the development of a registry of in-hospital CA in childhood. Its development will provide access to CPR data in different hospital settings and will allow the analysis of current controversies in the treatment of pediatric CA and post-resuscitation care. The results may contribute to the development of further international recommendations. Trial register: ClinicalTrials.gov Identifier: NCT04675918. Registered 19 December 2020 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04675918?cond=pediatric+cardiac+arrest&draw=2&rank=10

ISOLAMENTO HOSPITALAR PEDIÁTRICO: práticas e recursos na perspectiva da psicologia

The work’s aim is to identify practices implemented in hospital pediatric isolation in order to reduce psyhcic suffering. It is a qualitative, exploratory and descriptive study. A source triangulation methodology was used: (BVS-BIREME, PubMed, Google acadêmico and PsycINFO) open interviews with experienced professionals who were active in pediatric hospital services was done; and, an online search was done on techniques to humanize pediatric hospital isolation services. The results indicated scarcity of specialized literature, predominance of qualitative studies and tendency to value resources over relational resources, as well as the existence of practices lacking more scientific evidence. The employment of these practices depends on factors related to the lethality of the pathogen, the child’s age and concernment, the responsivity level, the access to material resources and the health team’s flexibility in regard to pondering about risks/benefits, experimenting with idiosyncratic practices.

Prevalence of Intestinal Nematodes among Children below 10 years attending Kiwoko Hospital Pediatric Unit, Kasana, Nakaseke, District, Uganda.

Background: Intestinal nematodes are among the most common parasites infecting humans in developing countries, precise estimates of the populations at risk of infection are difficult to derive. Therefore to understand the disease burden there is a need for reliable data on the prevalence of infection as well as information on the risk factors of infection. Methodology: 99 stool samples were collected from children who presented with diarrhea, fever, itchy anus opening all symptoms of intestinal nematode infection. Stool samples were screened using the direct saline method. Samples negative by direct saline were further examined using the formal ether technique and stained by eosin for visualization of parasites eggs. A questionnaire was administered to their guardians/parents to assess the risk factors of infection. Results: The prevalence of intestinal nematode infection was found to be 62.6% (62/99). The intestinal nematode infection rate was found to be higher in children over five years as compared to children below five years with a prevalence of 64.2% (43/67) and 59.4% (19/32) respectively. The prevalence of infection by sex was 66% (31/47) in males and 59.6% (31/52) in females. Ascaris lumbricoides were the most prevalent parasite identified in 25 of the 62 patients infected with intestinal nematodes. This was followed by Hookworm (17/62), Trichuris trichiura (12/62), and Strongyloides stercoralis(8/62). Poor hygiene was the most common risk factor cited followed by illiteracy and poverty. Conclusion and recommendations: The results show intestinal nematode infection is common in children attending the Kiwoko pediatric unit. This, therefore, calls for different stakeholders such as public health officers, medical personnel, and the community to develop new strategies to educate the community on existing government programs aimed at the elimination of intestinal nematode infection in children in the Nakaseke district.