Children's Ward Research Articles

Reducing neonatal admissions from home to the children's ward

This retrospective study of neonatal hospital admissions from home to the children's ward in 2007/2008 and 2008/2009 was conducted to ascertain if admissions had increased and what the pattern of these reflected. The findings were that neonatal admissions had increased but not significantly. Admissions associated with jaundice and feeding problems were the first and fifth most frequent reasons for admission respectively, accounting for high numbers of baby-days in hospital. High proportions of admissions in both categories required no overnight stay or only one night stay. A large number of babies required admission into the children's ward in the first month of life. A large portion of these admissions were for jaundice (20%) and feeding problems (10%) and in each category, a short stay in hospital predominated. There is potential to avoid such admissions, which might be amenable to management at home under the care of the midwife. The use of bilirubinometers in community midwifery practice might help reduce admissions for jaundice. A number of areas for further research are recommended. An important question to be examined is whether there is an association between neonatal hospital admissions and reduced home visits by midwives. In addition, more focused review of case notes of selected categories of neonatal admissions would enable exploration of social, economic, medical and other factors associated with neonatal hospitalization.

817 Oral-Facial Clefts/The Incidence, Causes and Symptoms at the Children Hospitalized in Children's Ward in Stip

Background: Oral-facial clefts are birth defects in which the tissues of the mouth or lip don't form properly during fetal development. The causes of these birth defects are not well understood, but believe it may be a combination of genetic and environmental factors (drugs, illnesses, and the use of alcohol or tobacco while a woman is pregnant) - multifactorial inheritance. Aim: To evaluate the incidence, causes and symptoms of oral facial clefts at the children's ward in Stip. Methods: After birth, cleft lip and palate are diagnosed by physical exam. Special exposure of their mothers during pregnancy indicates that environmental factors increase the risk of cleft lip and palate. Results: During the past 10 year children with oral facial clefts are borns in series in the same or closer month in the year. We councluded that every year the number od children with oral-facial clefts growing and they were not associated with any syndrome Their parents doesn't have a oral-facial clefts. Children with oral-facial clefts have special problems and complication like feeding difficulties, ear infections and hearing loss. Conclusion: The obtain results suggest that environmental factors, such as drugs (several different anti-seizure drugs) and maternal smoking, are risk factors for appearance of oral-facial clefts. Cleft lips and palates not associated with a syndrome are caused by a combination of genetic and environmental factors. Other environmental factors that are suspected of playing a role include infections, maternal alcohol use and deficiency of the B vitamin folic acid.

Review of childhood measles admissions at the National Hospital, Abuja.

The global disease burden from measles as a vaccine preventable disease remains high despite decades of interventions by various organs and agencies. To determine the prevalence and outcome of childhood cases of measles admitted into the children's emergency ward of the National hospital and highlight the possible contributing factors. Retrospective. A total number of 43 children with measles presenting at the National Hospital Abuja, seen over a 40 months period; January 2002 and April 2005. Cases-folders of patients seen at the Emergency Paediatric Unit (EPU) of the National Hospital Abuja during the period under review with the clinical diagnosis of measles were reviewed. The children were aged between seven to 12months, with 25 (58.1%) age 24months and below. Twenty three (53.5%) of the subjects had received prior measles vaccination. History of contact with cases of acute measles was present in 26 (60.5%). Associated protein energy malnutrition (PEM) was found in 30 (69.8%) with 28 (65.1 %) parents of these children being of lower social economic classes (III, IV &V). Recorded complications included gastroenteritis, bronchopneumonia, laryngo-tracheo-bronchitis as part of croup syndrome, tuberculosis, and otitis media. Three fatalities (7.0%) were record in this review, all in association with bronchopneumonia. Measles with its complications still present as a fatal illness even among vaccinated children.

Strengthening the emergency healthcare system for mothers and children in The Gambia

A system to improve the management of emergencies during pregnancy, childbirth, infancy and childhood in a region of The Gambia (Brikama) with a population of approximately 250,000 has been developed.This was accomplished through formal partnership between the Gambian Ministry of Health, the World Health Organisation, Maternal Childhealth Advocacy International and the Advanced Life Support Group.Since October 2006, the hospital in Brikama has been renovated and equipped and more efficiently provided with emergency medicines. An emergency ambulance service now links the community with the hospital through a mobile telephone system. Health professionals from community to hospital have been trained in obstetric, neonatal and paediatric emergency management using skills' based education. The programme was evaluated in log books detailing individual resuscitations and by external assessment.The hospital now has constant water and electricity, a functioning operating theatre and emergency room; the maternity unit and children's wards have better emergency equipment and there is a more reliable supply of oxygen and emergency drugs, including misoprostol (for treating post partum haemorrhage) and magnesium sulphate (for severe pre-eclampsia). There is also a blood transfusion service.Countrywide, 217 doctors, nurses, and midwives have undergone accredited training in the provision of emergency maternal, newborn and child care, including for major trauma. 33 have received additional education through Generic Instructor Courses and 15 have reached full instructor status. 83 Traditional Birth Attendants and 48 Village Health Workers have been trained in the recognition and initial management of emergencies, including resuscitation of the newborn. Eleven and ten nurses underwent training in peri-operative nursing and anaesthetics respectively, to address the acute shortage required for emergency Caesarean section.Between May 2007 and March 2010, 109 patients, mostly pregnant mothers, were stabilised and transported to hospital by the new emergency ambulance service.293 resuscitation attempts were documented in personal logbooks.A sustainable system for better managing emergencies has been established and is helping to negate the main obstacle impeding progress: the country's lack of available trained medical and nursing staff. However, insufficient attention was paid to improving staff morale and accommodation representing significant failings of the programme.

Stark contrasts in hospital care

As a third-year nursing student Sofia Razaq spent a four-week elective working in a children's ward in Morocco. In this article she describes the main differences between working there and in the U.K.

A need for play specialists in Japanese children’s wards

The importance of distraction techniques and play therapy for sick children has long been recognised by nurses in the UK and other western countries. Although these techniques are not so well established in Japan there is growing interest in them. The authors conducted a survey and found that children's nurses in Japan appreciated the value of distraction techniques and play therapy. They argue that attitudes to using them on children's wards in Japan are changing, but there is still a lack of training and few play specialists.

Swearing: its prevalence in healthcare settings and impact on nursing practice

Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nurses and nursing practice. Nurses are, of all health workers, most likely to be targets of verbal aggression, and up to 100% of nurses in mental health settings report verbal abuse. The literature contains no reference to the effects on nurses of exposure to swearing. This paper reports the findings of a questionnaire study of 107 nurses working in three clinical settings, which used a mixed methods approach. Participants reported high levels of swearing by patients, 32% citing its occurrence from one to five times per week and 7% 'continuously'; a similar incidence arose across the nursing teams at all sites, but being sworn at in anger by another staff member happened rarely. The study failed to show significant differences in the frequency of swearing between mental health and paediatric settings, but did find gender-based differences in both frequency of use and offendedness. High degrees of distress among nurses subjected to swearing were evident; moreover, respondents appeared to have only a limited range of interventions to draw upon in dealing with exposure to such treatment.

Evaluating venepuncture practice on a general children’s ward

To assess the training for, practice of, and effects of venepuncture in children on a general children's ward. To identify approaches that might reduce the adverse physical and psychological effects related to venepuncture. Questionnaire survey of 51 parents, 39 children and 72 junior doctors following venepuncture in the children. Telephone survey of 25 paediatric senior house officers on venous access training. Parents and children assessed venepuncture as extremely distressing. Parents' assessments of the mean number of venepuncture attempts were markedly higher than those of the doctors surveyed. When carrying out venepuncture, doctors used therapeutic measures much less frequently than expected. Only seven of the 25 departments surveyed offered any training in venepuncture. Venepuncture is consistently one of the most distressing aspects of hospital admission for children. Much could be done to alleviate this, but trainir patchy and interventions shown to reduce distress are not uniformly used.

Nurse-facilitated discharge for children and their families

This article explores the introduction of nurse-facilitated discharge in one children's day care unit. It highlights how a need for change to the discharge procedure was established and how the practice was developed, successfully introduced and subsequently reviewed. The author concludes that the process has improved patients' experience with families no longer waiting hours for a consultant to discharge them. It has relieved bed pressures and empowered staff to extend the process to inpatient children's wards.

Does Aggressive Refeeding in Hospitalized Adolescents With Anorexia Nervosa Result in Increased Hypophosphatemia?

Concerns about refeeding syndrome have led to relatively conservative nutritional rehabilitation in malnourished inpatients with anorexia nervosa (AN), which delays weight gain. Compared to other programs, we aggressively refed hospitalized adolescents. We sought to determine the incidence of hypophosphatemia (HP) in 12-18-year-old inpatients in order to inform nutritional guidelines in this group. A 1-year retrospective chart review was undertaken of 46 admissions (29 adolescents) with AN admitted to the adolescent ward of a tertiary children's hospital. Data collected over the initial 2 weeks included number of past admissions, nutritional intake, weight, height, body mass index, and weight change at 2 weeks. Serum phosphorus levels and oral phosphate supplementation was recorded. The mean (SD) age was 15.7 years (1.4). The mean (SD) ideal body weight was 72.9% (9.1). Sixty-one percent of admissions were commenced on 1,900 kcal (8,000 kJ), and 28% on 2,200 kcal (9,300 kJ). Four patients were deemed at high risk of refeeding syndrome; of these patients, three were commenced on rehydration therapy and one on 1,400 kcal (6,000 kJ). All patients were graded up to 2,700 kcal (11,400 kJ) with further increments of 300 kcal (1,260 kJ) as required. Thirty-seven percent developed mild HP; no patient developed moderate or severe HP. Percent ideal body weight at admission was significantly associated with the subsequent development of HP (p = .007). These data support more aggressive approaches to nutritional rehabilitation for hospitalized adolescents with AN compared to current recommendations and practice.

Evaluation of the nutritional status in children admitted to the neurology ward of Mofid children's hospital.

Objective is commonly considered as an important risk factor that can produce a negative influence on the prognosis of patients with chronic neurological diseases. We aimed to evaluate the nutritional status of patients admitted to the neurology ward of Mofid children’s hospital via subjective and objective methods. Materials & Methods 61 children (2-6 years of age) who were consecutively hospitalized at the neurology ward between January and March 2008 underwent objective (weight, height, mid upper arm circumference– MUAC- and triceps skinfold thicknessTSF) and subjective nutritional assessment. Results result showed that 42.6%, 37.7% and 25.9% of patients were consecutively wasted, underweight and stunted. The z- Scores for TSF and MUAC were below -1 in 32.7% and 41.8% of the patients, consecutively. According to subjective Assessments (SGNA), 52.7% were malnourished. The prevalence of malnutrition was not significantly different between sex or diagnosis groups Conclusion is of high prevalence in patients with neurologic diseases. Regular

Helen Taussig: Children's Cardiologist

When I was a medical student in the 1940's, we were familiar with ‘Blue Babies' in the children's medical wards. Cyanosed, breathless to the extent of being unable to lie down, and with no effective treatment available, they were condemned to a miserable life and early death. Many of these children suffered from Fallot's tetralogy, where the main problem is stenosis of the pulmonary artery. This greatly diminishes the flow of de-oxygenated blood from the right side of the heart to the lungs.

Characterization and Treatment of Severe Malaria in Hospitalized Children at a Ghanaian District Hospital

Objective: To document the demography of paediatric admissions due to severe malaria, presentation and determinants of clinical symptoms and treatment for the condition at the KNUST Hospital, Ghana. Methods: A prospective, non-randomized, observational study was undertaken at the Children's Ward of the KNUST Hospital, in Kumasi. During a one month period, the symptoms on admission, treatment and treatment outcome of included children were documented. Inclusion criteria were age 0-144 months, verbal informed consent and severe malaria defined by presence of asexual Plasmodium falciparum parasitaemia coupled with at least one criterion suggestive of severe malaria as defined by WHO. Results: Overall, there were 82 malaria admissions with 69 cases being enrolled. On admission, mean haemoglobin levels were consistent for both males and females. Mean body weight was higher for females. Main presentations were anaemia of moderate to severe form (56); fever (52) and convulsions (24). Prostration was observed in all cases. Children under 5 years of age were associated with anaemia (p=0.018) and neurological symptoms (p=0.003). Clinical presentation of severe malaria was found to be independent of patients' sex. Quinine was used as treatment in 17 cases; monotherapy with artemisinin derivatives in 26 cases and artemisinin-amodiaquine combinations in 19 of the cases. No deaths were recorded. Conclusions: Children under 5 years of age presented more often with severe malaria. Prostration, anaemia and neurological symptoms were the most frequent manifestations.

Historical Perspectives

James Watson Farquhar was born in Edinburgh, Scotland, in 1922; went to school at George Watson's College, Edinburgh (where he played for the Rugby 1st XV); received his medical education at the University of Edinburgh; spent his entire academic career in the Department of Child Life and Health of Edinburgh University; and died in Edinburgh in 1998. If this suggests that Jim was a provincial, “stay at home” type, lacking a spirit of adventure, nothing could be further from the truth. Perhaps the phrase that captures him best is that he was “a peripatetic personality.” He was a cheerful, dynamic person, who always seemed to be “on the go.” I can see him still, marching briskly between the Royal Hospital for Sick Children (RHSC), where he was in charge of a children's ward that specialized in metabolic problems, and the offices of the Department of Child Life and Health. Of course, he may have been walking briskly because of the climate in Edinburgh, which is not known for high temperatures, and Jim apparently reveled in higher temperatures. However, he could appreciate a cool, crisp, sunny day, too! As a result of his early research activity, he became a “world traveler” who had a profound interest in the pediatric problems of many different countries, but in particular those of the developing world. This is exemplified by his volunteering in 1963 to lead the first batch of medical teachers in an exchange program between Edinburgh University and the University of Baroda in Gujarat state in India, which was sponsored by the World Health Organization. He took his wife and two children to live there for a year and made a very important contribution. Jim may have developed a taste for travel soon after finishing medical school. He entered medical school in …

Comparison of the Use of Liquid Crystal Thermometers with Glass Mercury Thermometers in Febrile Children in a Children's Ward at Port Moresby General Hospital, Papua New Guinea

We compared the temperatures recorded, in febrile children admitted to a children's ward at Port Moresby General Hospital, by a doctor and by a group of nurses using glass mercury thermometers (GMT) and liquid crystal thermometers (LCT, Nextemp and Traxit. The mean difference (with 95% confidence intervals) in temperatures between GMT and Nextemp were -0.12 degrees C (-0.16 degrees C to -0.08 degrees C) for the doctor and 0.12 degrees C (0.04-0.20 degrees C) for nurses. The mean difference in temperatures between GMT and Traxit were -0.05 degrees C (-0.09 degrees C to -0.01 degrees C) for the doctor and 0.19 degrees C (0.10-0.28 degrees C) for the nurses. A similar result was obtained when one of the Nextemp thermometers used in the initial study was compared with GMT on a small sample of patients by the doctor 8 months later. Limited evaluation showed nursing staff were in favour of using the LCTs. Nextemp and Traxit thermometers can be used interchangeably with GMT in this setting.

Geoff Foster: paediatrician remaining hopeful in Zimbabwe

Geoff Foster: paediatrician remaining hopeful in Zimbabwe

Changing attitudes towards the care of children in hospital: a new assessment of the influence of the work of Bowlby and Robertson in the UK, 1940–1970

It is generally believed that the work of Bowlby and Robertson was new and decisive in changing the hospital conditions for young children. The fact that parents in the UK and other European countries can now visit their sick child at any time they wish or even room-in is attributed to an acquaintance with Bowlby's findings and Robertson's well-known films about the potentially detrimental effects of hospital stays for young children. In this paper we shall argue that this picture is incomplete and that, historically, things were rather more intricate. Bowlby and Robertson were neither the first nor the only researchers who tried to change hospital policies. Moreover, the older hospital policies were not uniformly bad. Long before Bowlby and Robertson began their plea for reforms, several individuals and hospitals had already introduced conditions that we now still regard as exemplary. The whole change towards more liberal, flexible, and humane practices in children's wards took place over several decades and was fuelled by both worried medical doctors, pressure groups of parents, sympathetic editors of medical journals, and emerging new research findings such as those provided by Bowlby and Robertson. In that societal debate, the voices of Bowlby and Robertson were influential but not necessarily new or decisive.

Use of single rooms on the children’s ward, part 2: guideline for practice

Most general children's wards have a limited number of single rooms available. This article presents evidence-based guidelines for practice developed in collaboration between several NHS trusts and a higher education institution, to ensure the effective and equitable use of this limited resource. The evidence underpinning the guideline was presented in part one, published in the December 2008 issue (Rose and Blythe 2008). The guideline covers the use of single rooms for control of infection, meeting psychosocial needs and in response to family preferences. It also provides guidance on action to be taken when no single room is available. This guideline provides a tool for staff to make clear to parents why their child was, or was not allocated a single room and the reason why if a child was moved out of a single room. It is also a resource for teaching students about the purposes and effects of isolation nursing on a children's ward.

Psychiatric Unit, Children's Ward, Night Shift

Psychiatric Unit, Children's Ward, Night Shift

The first case of isolated facial cutanenous leishmaniasis in a Down syndrome infant: a case report and review of the literature

BackgroundCutaneous leishmaniasis can be caused by several Leishmania species and is transmitted to human beings and animals by sand flies, Down syndrome is known to cause immunodeficiency that might lead to increase the susceptibility to infection with Leishmania.Up to our knowledge this is the first case of isolated facial cutaneous leshmaniasis in association with Down syndrome.Case presentationA 2 month old Saudi Arabian male infant was admitted in the pediatric ward of maternity and children's hospital, Buraidah, Kingdom of Saudi Arabia for the management of multiple ulcers on his face, two ulcers were big and were surrounded by edema, causing severe disfigurement. This disfigurement caused difficulty in recognizing the facial feature of Down syndrome. The presence of hypotonia, microcephaly, low set ears, bilateral simian creases and wide separation between big toe and other toes directed us to request karyotyping. The result of karyotyping confirmed the diagnosis of Down syndrome.ConclusionChildren with Down syndrome are immunodeficient, they have been reported to have a complex of immunological alterations which might lead to increased susceptibility to infection.