Highlights in this issue

Abstract

Björn Lundberg et al report that hospital-assisted home care after early discharge from a Swedish neonatal intensive care unit (NICU) between 2002 and 2011 was safe for the vast majority of infants (94.8%) 1. However, Gorm Greisen, who recently published experiences from an early discharge programme in Denmark 2, expresses his concerns in the accompanying editorial 3. Two cases of sudden infant death syndrome out of a combined total of 2000 infants suggest that there may be a problem. Readers may also be interested to see the paper by Charlotta Robinson et al 4, who report that using telemedicine to help care for newborn infants after their NICU discharge reduced the need for hospital visits. Drowning has been described as a secret epidemic in Bangladesh. Mosharaf Hossain et al held focus groups with parents and community leaders in rural Bangladesh in an attempt to develop an intervention package that prevented children under the age of five from drowning. Most drownings occurred around lunchtime and the risk factors included children not being able to swim, unfilled ditches, lack of medical facilities and lack of parental awareness. The authors concluded that a safety education programme could be effective in increasing knowledge and changing attitudes among parents and reduce the number of young children drowning in the country 5. Stephanie Kukora and Naomi Laventhal suggest that adults who refuse the influenza vaccine should not receive extracorporeal membrane oxygenation (ECMO) during influenza epidemics if resources are scarce. The authors share their own experiences from a cold night in January 2013, when a severely ill newborn baby risked being refused ECMO as the H1N1 flu epidemic meant that the pressure on equipment and staffing levels had reached breaking point 6. Tracy K Koogler and Michael Broomé discuss the ethical dilemma of medical decision-making in times of scarce technological and human resources 7, 8. Children with refractory or high-risk malignancies frequently suffer from poor quality of life during palliative care. In this Finnish study by Mikaela Porkholm et al, 17 children with end-stage malignancies achieved a significantly better quality of life when they received low daily doses of chemotherapy 9. However, 76% of the patients experienced serious adverse events, emphasising the need for careful patient selection to minimise the risk of toxicity. Nicolas Andre et al comment on the findings 10. Distraction is a useful intervention for venipuncture pain in children, but there is no evidence of which distraction technique is the most useful. This randomised controlled trial by Franca Crevatin et al compared the efficacy of children playing the Angry Bird game on a hand-held computer with nurse-led distraction in a blood drawing centre in Italy. Only one in six children in the computer game group reported pain during venipuncture, which was as effective as being distracted by nurses 11.