College Of Paediatrics Research Articles

Delayed Cord Clamping at Delivery of a Newborn- A Position Statement by the College of Paediatrics and the College of Obstetricians and Gynaecologists, Academy of Medicine of Malaysia

Delayed Cord Clamping at Delivery of a Newborn- A Position Statement by the College of Paediatrics and the College of Obstetricians and Gynaecologists, Academy of Medicine of Malaysia

Appendiceal involvement in pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a diagnostic challenge in the coronavirus disease (COVID) era

BackgroundMany studies on pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS) have described abdominal findings as part of multisystem involvement, with limited descriptions of abdominal imaging findings specific to PIMS-TS.ObjectiveTo perform a detailed evaluation of abdominal imaging findings in children with PIMS-TS.Materials and methodsWe performed a single-center retrospective study of children admitted to our institution between April 2020 and January 2021 who fulfilled Royal College of Paediatrics and Child Health criteria for PIMS-TS and who had cross-sectional abdominal imaging. We studied clinical data, abdominal imaging, laboratory markers, echocardiography findings, treatment and outcomes for these children. We also reviewed the literature on similar studies.ResultsDuring the study period, 60 PIMS-TS cases were admitted, of whom 23 required abdominal imaging. Most (74%) were from a Black, Asian or minority ethnic background and they had an average age of 7 years (range 2–14 years). All children had fever and gastrointestinal symptoms on presentation with elevated C-reactive protein, D-dimer and fibrinogen. Most had lymphopenia, raised ferritin and hypoalbuminemia, with positive severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibodies in 65%. Free fluid (78%), right iliac fossa mesenteric inflammation (52%), and significantly enlarged mesenteric lymph nodes (52%) were the most common imaging findings. Appendiceal inflammation (30%) and abnormal distal ileum and cecum/ascending colon wall thickening (35%) were also common. All children responded well to medical management alone, with no mortality.ConclusionIn addition to free fluid, prominent lymphadenopathy, and inflammatory changes in the right iliac fossa, we found abnormal long-segment ileal thickening and appendicitis to be frequent findings. Recognition of appendiceal involvement as a component of the PIMS-TS spectrum should help clinicians avoid unnecessary surgical intervention as part of a multidisciplinary team approach.

Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): a Brazilian cohort

BackgroundPaediatric inflammatory multisystem syndrome (PIMS) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been described since mid-April 2020 with the first reports coming from Europe. Our objective was to describe the characteristics of patients among the Brazilian population.MethodsA multicenter retrospective study was conducted with the participation of five pediatric rheumatology centers in Brazil during the period from March to November 2020. Children and adolescents with PIMS temporally associated with SARS-CoV-2 (TS) who met the definition criteria for the disease according to the Royal College of Paediatrics and Child Health were included. Demographic, clinical, laboratory, therapeutic characteristics and molecular and serological diagnosis of SARS-CoV-2 infection were described.ResultsFifty-seven children and adolescents with PIMS-TS were evaluated, 54% female, with a median age of 8 (3–11) years. Most (86%) were previously healthy, with asthma being the main comorbidity, present in 10% of the patients. Fever was the main manifestation, present in all patients, followed by mucocutaneous and gastrointestinal features, present in 89% and 81% of the patients, respectively. Myocarditis occurred in 21% of the patients and in 68% of them required intensive care. The Kawasaki disease phenotype occurred in most patients (77%). All patients had elevated inflammatory markers, with elevated CRP being the most found (98%). Anemia and lymphopenia were present in 79% and 72%, respectively. Laboratory evidence of SARS-CoV-2 was found in 77% of the patients, with 39% positive RT-PCR and 84% positive serology for SARS-CoV-2. An immunomodulatory treatment was performed in 91% of the patients, with 67% receiving intravenous immunoglobulin (IVIG) associated with glucocorticoid, 21% receiving IVIG, and 3.5% receiving glucocorticoid. The median length of hospitalization was 10 days.ConclusionsThis study showed a high morbidity of PIMS-TS in Brazilian children, with a prolonged length of hospitalization and a high rate of admission to pediatric intensive care unit. Multicenter prospective studies are needed to assess the morbidity of the disease in the medium and long term.

198 A Novel ‘Virtual Simulation’ for The Advanced Life Support Group, Making a Dream a Reality: A Beginner’s Guide

In the UK, it is a requirement for staff involved in paediatric critical care to remain up to date with advanced paediatric life support (APLS). To do so there is an expectation to participate in face-to-face courses on a four-yearly basis. The Advanced Life Support Group (ALSG), an organization dedicated to supporting professional education, sought to add to their resources in line with advances in online capabilities. With stakeholder input, the goal emerged to develop an engaging, interactive and entirely novel educational product. Here we present the pilot stages of our project.The aim of this project was to produce an educationally effective and novel product that learners of APLS would engage with and enjoy.Stage 1 involved determining clearly defined learning objectives mapped to the APLS curriculum. At a round table with stakeholders, educationalists, and a technologist an outline of the project was formed and the scenario of a sick baby with bronchiolitis chosen for a pilot. Informed by literature on serious game design, a branching narrative was created. Stage 2 involved collating resources. A photoshoot at Leicester Royal Infirmary A&E (Accident and Emergency) created a set of images. A video shoot at the Royal London Hospital A&E generated a series of videos. These were then edited and used to create a Microsoft PowerPoint slide set. Voiceovers to text, sound effects to add a hospital atmosphere and questions were then added. Stage 3 involved taking this draft and translating it into an interactive final product utilizing Articulate Software. This enabled its usage across smartphone, desktop, and laptop devices. Testing followed with anonymous online feedback informed by the 7Is framework We launched the pilot version at the RCPCH (Royal College of Paediatrics and Child Health) Conference 2021. Feedback was collected from delegates and continues to be collected via online participants. It is hoped that ongoing quality improvement cycles will assist in assuring a finished fully functional online virtual advanced paediatric life support simulation for release in 2022. Further stakeholder review is pending. Thus far it has been met with universal approval, i.e. all learners questioned expressed that they would like to utilize this novel style of education again. The average duration to complete the virtual simulation was 15 minutes. All learners rated their knowledge and skills in APLS to be either unchanged/revised or improved. Finally, interactivity online was felt to need improvement by most participants. Interactivity is key if high levels of engagement are to be achieved. Future testing will determine whether any educational impact is maintained across time. The current pilot version can be accessed at the following webpage

CRITICAL-CARE DECISIONS ON NEONATES AND YOUNG CHILDREN IN ENGLAND AND WALES – LESSONS FOR SOUTH AFRICA

In this article it will be pointed out that in South Africa there are currently insufficient measures in place to protect the child patient, especially the neonate. A perusal of the case law of England and Wales reveals that in a number of cases on critical-care decisions the courts have used their opportunities to lay down criteria on issues such as the withholding or withdrawal of treatment in neonatal intensive care. These cases and the principles laid down in them may serve as precedents for South African case law. The English and Welsh courts have also provided guidelines on the interpretation of the best-interests standard in critical-care decisions. Guidelines on critical-care decisions were drafted by the Royal College of Paediatrics and Child Health, as well as the Nuffield Council on Bioethics. South Africa lacks suchcomprehensive guidelines on critical-care decisions concerning children. It is suggested that a comprehensive set of guidelines be drafted specifically for the unique South African position.

User-driven, open-source diabetes technology (special issue): Paediatric DIY APS.

Do-it-yourself artificial pancreas system (DIY APS) uses tailor-made open-source software technology and algorithms to achieve automated insulin delivery (AID) systems which are not commercialised or regulated1 . There is currently no guidance in the United Kingdom (UK) National Health Service (NHS) on the use of DIY APS in children and young people, nor are there any guidelines given by the UK General Medical Council or Royal College of Paediatrics and Child Health to assist healthcare professionals looking after children's diabetes.

START – evaluating a novel assessment of consultant readiness in paediatrics: The entry not the exit

The Royal College of Paediatrics and Child Health (RCPCH) incepted a new end-of-training assessment in 2012, known as START, the Speciality Trainee Assessment of Readiness for Tenure [as a Consultant]. It is a novel, formative, multi-scenario, OSCE-style, out-of-workplace assessment using unseen scenarios with generic, external assessors undertaken in the trainees’ penultimate training year. This study considers whether this assessment assists in preparing senior paediatric trainees for consultant working. A mixed qualitative and quantitative study in the post-positivist paradigm was designed. Subjects were paediatricians who have taken START and completed their paediatric training. Methods were an on-line questionnaire survey and a key informant interview. The assessment is viewed positively, but some trainees report negative experiences. They find value in the formative feedback which generally helps direct trainees towards focussing their training in their final year before ending their training and consultant appointment. For many respondents, the assessment highlighted areas for further development, was relevant for consultant working and useful for consultant interview preparation. Of least value was travelling, cost, assessor performance, feedback quality, feeling like a summative exam and sub-speciality involvement. Many respondents felt the assessment highlighted areas to develop in their subsequent training. Overall START supports transition to consultant working.

Statistics at square zero: a survival guide

Abstract In order to understand or conduct research, it is important that all clinicians have at least a basic grasp of the commonly encountered statistical tests. Each has its limitations but there is usually a best or more appropriate test to use for a given set of data. This is a key skill for all clinicians and is one of the curriculum competencies identified by the Royal College of Paediatrics of Child Health. Much to the chagrin of many trainees it is also tested in the RCPCH examinations. A basic understanding of some of the more commonly encountered tests is helpful: it allows a more thorough appreciation of the data that are being presented in published studies and for those undertaking the RCPCH Theory and Science examination offers ‘marks for free’. This short article provides simple guidance on how to pick the best test to use for different types of data. It is aimed at a novice who might consider themselves to be at step zero rather than step one.

A pilot of the Paramedic Advanced Resuscitation of Children (PARC) course

Paramedics are the primary providers of prehospital care to children in an emergency. However, they deal with children's emergencies infrequently, and consistently report a lack of confidence in this area. The Royal College of Paediatrics and Child Health standards state that clinicians with Advanced Paediatric Life Support (APLS) training or equivalent must be available at all times to deal with emergencies involving children. While APLS is widely recognised as the gold standard in paediatric training, it focuses on in-hospital providers of paediatric life support, so may not adequately meet the needs of prehospital providers. The Paramedic Advanced Resuscitation of Children (PARC) course attempts to condense the most important aspects of APLS for paramedics into a simulation-based programme that is practical and cost effective. Evaluation of the views of the eight paramedics who took part in the pilot revealed that they felt more confident in managing children's emergencies after attending the course. The PARC course may be a simple, cost-effective method to improve paramedics’ confidence in dealing with emergencies involving children.

Understanding barriers for research involvement among paediatric trainees: a mixed methods study

BackgroundChild Health research is reported to be at worryingly low level by the Royal College of Paediatrics and Child Health. Recent survey showed that 54.5% of paediatric consultants in the United Kingdom do not do any research at all. We conducted a mixed methods study to understand barriers and facilitators for research involvement among paediatric trainees who are going to fill these consultant posts in the future.MethodsA questionnaire based on a validated index for research and development was completed by 136 paediatric trainees within a region in the North of England (Yorkshire and Humber). Twelve semi-structured interviews were conducted with stratified purposive sampling. Descriptive statistics and Chi-Square test for independence were used for quantitative analysis. Thematic content analysis was done for interviews based on analysis method framework.Results136 out of 396 trainees responded to the survey. There was a significant relationship between confidence in using research in practice and ability to understand research terminology. This was not related to research experience or training. Males were significantly more likely to have presented a research paper, know how research influences practice and have more confidence in using research in practice than females. There was no significant relationship between gender and research training or highest qualification. Time constraints and lack of academic culture were the most frequently mentioned barriers in the survey.Over-arching themes identified from the interviews were related to lack of academic culture, opportunities provided in current training scheme and constraints related to time availability along with workforce management.ConclusionPaediatric research requires a supportive academic culture with more flexibility in training scheme and immediate attention to a pressing staffing crisis.

Developing standards of care for children with ongoing health needs.

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a recently published report from a consortium of health agencies led by the Royal College of Paediatrics and Child Health.

“Let's Bring Her Home First.” Patient Characteristics and Place of Death in Specialized Pediatric Palliative Home Care

ContextSpecialized pediatric palliative home care (SPPHC) is the main pediatric palliative care structure in Germany. Detailed data on patient characteristics and care are sparse. Describing this population in terms of diagnoses and care needs is essential for further development of palliative care services for these patients. ObjectivesWe asked whether the population at our center 1) was representative compared with national mortality statistics; 2) showed differences in the clinical course among the four diagnostic categories established by the Association for Children with Terminal Conditions/Royal College of Paediatrics and Child Health; and 3) was different to published populations in pediatric palliative care regarding diagnoses, care, and place of death. MethodsRetrospective single center chart analysis of 212 consecutive patients on SPPHC (2009–2015). ResultsMain International Statistical Classification of Diseases and Related Health Problems, 10th Revision groups were nervous system, congenital abnormalities, neoplasia, and metabolic disease, reflecting the mortality statistics for patients one to 20 years. Thirty-six percent of patients were assigned to ACT-3, 34% to ACT-4, 26% to ACT-1, and 4% to ACT-2. ACT-1 patients mostly needed high-intensity care for short durations, ACT-4 patients showed long survival times with mostly intermittent care. Seventy-five percent of patients showed nervous system involvement. Eighty-four percent died at home, 12% in hospital, and 4% in a hospice, with 96% dying at their preferred place. ConclusionOur data on SPPHC show 1) significant differences between Association for Children with Terminal Conditions/Royal College of Paediatrics and Child Health groups in terms of care needs and survival; 2) a high prevalence of children with neurological problems; and 3) a large majority of children dying at home.

Five facts about the paediatrician workforce

The Royal College of Paediatrics and Child Health (RCPCH) has published a report on the paediatric workforce. The report is based on figures from the college’s 2015 workforce census, Office for National Statistics data, and information from the college’s trainee recruitment processes. Hospital admissions for children in England rose by 25% between 2013/14 and 2015/16, from …

Health and well-being of UK children in 'jeopardy'.

A new report from the Royal College of Paediatrics and Child Health (RCPCH) warns that the health and well-being of children is falling behind that of many other European countries.

Don’t impose new contract on junior doctors, royal college urges Hunt

The president of the Royal College of Paediatrics and Child Health has written to the health secretary to urge him to rethink his decision to impose a new contract on junior doctors. Neena Modi wrote to Jeremy Hunt on 14 July, to congratulate him on his re-appointment as secretary of state for health. In the letter she said she was also writing …

Royal colleges work to broker a junior contract deal

Medical royal colleges are working behind the scenes to broker a deal between junior doctors and the government, and prevent the first all out strike by junior doctors in England. Meetings and discussions between government officials, heads of royal colleges, senior doctors, and senior health service figures have sought to break the deadlock between the government and the BMA over changes to junior doctors’ contracts. The King’s Fund’s chief executive, Chris Ham, called on the royal colleges to intervene to resolve the current dispute.1 He argued that although contract negotiations lay outside the responsibilities of the medical royal colleges their presidents have on previous occasions stepped outside their formal responsibilities to protect patient care. A spokesman for the Royal College of Emergency Medicine said that medical royal colleges were considering a move to work together to broker an agreement between doctors and the government. The Advisory, Conciliation, and Arbitration Service, which previously facilitated talks between the BMA and the government, confirmed that its “door will remain open to both parties.” Neena Modi, president of the Royal College of Paediatrics and Child Health said, “The medical royal colleges have a role to play …

Few paediatricians have time for research, survey finds

Over 80% of paediatricians have no time for research work, the Royal College of Paediatrics and Child Health has found. The college surveyed paediatric consultants and staff grade doctors, from whom it received 1924 responses. Of the respondents, 82% (1311) said that they did not have any time in their job plan that was allocated to research. Four fifths (1149) of the …

Health Professionals Perspectives of Care for Seriously Ill Children Living at Home

IntroductionGlobal advances in medical knowledge and technology have resulted in increased survival of neonates with complex illnesses. Many of these neonates now live into childhood, however their care requirements have become more complex (Elias & Murphy, 2012; Maddox & Pontin, 2013; Schuster, Chung, & Vestal, 2011). Previously these children remained in a hospital setting, however the contemporary care setting is the family home with parents the primary carers and providers of their child's technical and personal cares (Dybwik, Tollali, Nielson, & Brinchmann, 2011; Elias & Murphy, 2012; Hewitt-Taylor, 2012; Maddox & Pontin, 2013; McCann, Bull, & Winzenburg, 2012). Parents/ families are now required to learn how to safely and effectively deliver technical interventions, following instruction from community nurses. Some examples of these interventions are: oxygen and ventilation therapy, tracheotomy care, suctioning, feeding-tube care, intravenous nutrition and intravenous drug regimens (Eilas & Murphy, 2012; Maddox & Pontin, 2013; Shuster et al., 2011; Whiting, 2013).Shuster and colleagues (2011) described care provided by parents/families as a 'shadow health care' (p. 91) system upon which health care services rely. Publically funded child health care systems would be unable to function without this level of parental support (Shuster et al., 2011). Buhler-Wilkerson (2007) argued home care could be the cornerstone of a system to meet the needs of the chronically ill. However, the management of technical, physical and emotional care for children at home has a direct impact on the parent/family in terms of physical, mental health and emotional resilience. Parents often have been found to experience altered roles, financial burden, marital strain, psychological distress (Carnevale, Alexander, Davis, Rennick, & Troini, 2006; Ling, 2012; Santacroce, 2003; Schuster et al., 2011; Whiting, 2013) and low quality of life (Al-Gamal, 2013). There continues to be the question of how to deliver funded care that has the potential to reduce the physical, emotional and financial burden for parent/family carers (BuhlerWilkerson, 2007; Shuster et al., 2011).It is important that home care for seriously ill children with complex medical needs is provided in the context of a child health model of care that is family-centred and that a partnership forms between the child, family and health professionals. Fowler et al. (2012) highlight that nurse partnership activities are not new to nurses who work with parents. Fowler and colleagues (2012) argue that partnership requires nurses to skilfully create the conditions for an effective relationship to emerge. This then provides opportunity for optimal collaboration and coordination to enhance better outcomes in care (Barnes & Rowe, 2008; Denboba, McPhearson, Kenney, Strickland, & Newacheck, 2006; Fowler et al., 2012; Kenny, Denboba, Strickland, & Newacheck, 2011; Price & McNeilly, 2009; Simkiss, 2011; Yarwood, 2008).The research reported here aims to contribute to the body of knowledge on the topic of health related care for seriously ill children living at home and health service evaluation. This has significance for medical, nursing and allied health professionals who care for seriously ill children and their families.BackgroundIt has been well established that families benefit from health care that is provided in an integrated and co-ordinated way, particularly when the child is being treated in their home (American Academy of Pediatrics: Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee, 2014; Association for Children with LifeThreatening or Terminal Conditions and their Families, & Royal College of Paediatrics and Child Health, 2003; Ministry of Health, 2010). Many of these children have complex and disabling health needs, sometimes requiring palliation. …

Contributing towards improved end of life care for children

The Royal College of Paediatrics and Child Health has recently updated the end of life care framework for children. Ian Peate looks at the new guidance and the role school nurses can play in supporting children and their family.

Advocating for children in a rapidly changing world

Integrated working was high on the agenda at the annual conference of the Royal College of Paediatrics and Child Health, held in Birmingham over 3 days in April.