Outpatient Management Of Children Research Articles

Ready to-Use Supplementary Food in the Outpatient Management of Children with Acute Malnutrition in Basrah

Summary Background Ready-to-use supplementary foods are high-energy, lipid-based provide energy, protein, fat, vitamins and minerals to treat acute malnutrition in children aged 6 -59 months. Aim To evaluate the effect of ready-to-use supplement foods on the outpatient management of children with acute malnutrition. Methods A prospective appropriate study was carried out on children with acute malnutrition who were referred to the nutritional rehabilitation center at Basra Teaching Hospital; were received ready-to- use supplementary foods at a quantity sufficient to meet their nutrient requirements for full catch- up growth and followed at two subsequent visits Results Moderate wasting and underweight recorded in (66.7 %) and severe wasting in (33.33%) of the patients. Mean weight gain at the first and second follow-up visit was (5.78 ±2.43) and (6.52 ±2.75) g/kg/day respectively. There was a significant improvement in the weight for height Z score at the first and second follow-up visits after the administration of ready-to-use supplementary foods (P value < 0.05). Approximately 32% of the children aged 12-18-month experienced moderate weight gain. Bottle feeding with complementary feeding was reported in 24.19% of the children with moderate weight gain, and 9.52% and 34.68% of the children of illiterate parents and unemployed fathers respectively, showed moderate weight gain. Children belong to families with low income group accounted for 37.09% of those with moderate weight gain. Family income was the only variable that depend on the weight gain results (P value < 0.05). Conclusion: Ready-to-use supplementary food is significantly effective for outpatient management of acute malnutrition. Key words: Acute Malnutrition, Ready-to-Use Supplementary Food, Outpatients

Successful Outpatient Management of Children at a Secondary Care Hospital in Pakistan in a Dengue Fever Epidemic and Their Clinical Outcomes.

Background There is limited published literature on the feasibility of WHO 2009 guidelines for the management of dengue fever (DF) in Pakistani children. This study aimed to assess the outcome of children with DF who received outpatient treatment according to these guidelines during a DF epidemic. Method This was a prospective cohort study conducted at Federal General Hospital, a secondary care hospital, Islamabad, Pakistan, from 1st August to 31st October 2019. Using WHO DF 2009 guidelines, children ≤13 years, diagnosed as confirmed DF (NS1 Ag +), were classified into the outpatient (DF) or the inpatient group (DF with warning signs or severe dengue (SD)). The inpatient group was admitted to the Pakistan Institute of Medical Sciences, a tertiary care hospital, and discharged on recovery. These children were followed for the primary outcome, i.e., recovery or hospitalization by day 14 of enrollment. Additionally, clinical and laboratory features (Hb, HCT, TLC, PLT, and ALT) of the patients in the outpatient who remained stable with those who progressed to inpatient care during follow-up were compared; also, time of recovery of blood counts was assessed. Results Of 93 children with DF, 87 (93.5%) received outpatient care at enrollment. Of these, 6 (7.8%) deteriorated by day 7 and were admitted to inpatient care. SD was present in 6/93 (6.4%) patients at presentation and were admitted. All children showed signs of recovery until day 14. Male gender (p=0.049), lower normal mean platelet (p=0.02), and high mean hematocrit (p=0.001) were associated with disease progression. Conclusion The majority of children with confirmed DF who received outpatient treatment according to WHO 2009 guidelines were successfully managed. Additionally, confirmed DF with warning signs or SD were admitted and recovered. Regular follow-ups according to the guidelines are pertinent. Thrombocytopenia and high HCT were associated with disease progression.

Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference.

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children and adolescents. Survivors of severe TBI are more prone to functional deficits, resulting in poorer school performance, poor health-related quality of life (HRQoL), and increased risk of mental health problems. Critical gaps in knowledge of pathophysiological differences between children and adults concerning TBI outcomes, the paucity of pediatric trials and prognostic models and the uncertain extrapolation of adult data to pediatrics pose significant challenges and demand global efforts. Here, we explore the clinical and research unmet needs focusing on severe pediatric TBI to identify best practices in pathways of care and optimize both inpatient and outpatient management of children following TBI.

Experiences with use of a pulse oximeter multimodal device in outpatient management of children with Acute Respiratory Infection during Covid pandemic.

Background:While Covid-19 infection rate in children is low, respiratory symptoms are a common mode of presentation which calls for better management of such symptoms. However, ARI case managemnet in primary health settings settings has challenges as health workers lack skills to count respiratory rate and check chest indrawing. To address this multimodal pulse oximeters have been introduced in health and wellness centres of seven states to ease the work of front line health workers. A study was undertaken to understand the usability of the multimodal pulse oximeter during Covid times.Methods:A qualitative study was conducted with the aid of indepth interviews among a convenience sample of eleven health care workers from ten health and wellness centres. Interviews were conducted and recorded over phone, after obtaining consent. Transcribed interviews were coded and analysed on a qualitative analysis software. Content analysis was conducted.Results:Total children screened during covid lockdown period (April 1-May 31) is 571, those diagnosed with pneumonia and severe pneumonia is 68 and 2. Health care workers were satisfied with pulse oximeter as it helped in timely diagnosis and treatment, and offered protection from possible infection as it mitigated the need for physical contact.Conclusion:The multimodal pulse oximeter is well accepted among providers as it is easy to use aiding in timely management of ARI in children. It has an added protection as it's use reduces the need for physical contact. It can be adopted in other HWC and primary health facilities.

Virtual Outpatients

The new normal in the outpatient management of children.&#x0D; How hospitals managed appointments throughout Covid-19, from people not attending due to fear through to taking appointments online to ensure the safety of patients and staff.

288 Characteristics and Outcomes of Patients with Ventricular Assist Devices Presenting to a Pediatric Emergency Department

Ventricular assist devices (VADs) are being used more frequently in pediatric patients with advanced heart failure. Outpatient management of children with VAD implantations also is becoming more common. However, no study exists that describes Emergency Department (ED) care of these patients. This study aims to identify patient characteristics and outcomes of children with VADs presenting to the ED. This is a retrospective descriptive study of all patients ages 0 to 18 years in the Stanford Children’s outpatient VAD program who presented to our pediatric ED between 2010 (year of first discharged VAD patient) and 2020. Patient data was abstracted from electronic medical records. Adverse events were defined according to the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry guidelines. Adverse events were included if they occurred during the ED visit or associated hospitalization. A total of 30 children with VAD implantations were transitioned to outpatient care in the study period. All were implanted with continuous flow devices. Among children in the outpatient VAD program, 20/30 (66.7%) had 38 visits to our pediatric ED over 141.5 patient-months. Median age of patients at time of ED visit was 12.5 (range 7.3-17.4) years. Median number of ED visits per discharged child was 1 (range 0-4). The most common complaints on arrival to ED included fever (7/38; 18.4%), abdominal pain or vomiting (7/38; 18.4%), headache (6/38; 15.8%), bleeding from any site (4/38; 10.5%), chest pain (4/38; 10.5%), device malfunction or alarm (3/38; 7.9%), dizziness (3/38; 7.9%), and dyspnea (3/38; 7.9%). Adverse events occurred during 14/38 (36.8%) ED visits or associated hospitalizations, including 3/38 (7.9%) instances each of hypertension, major infection, or right heart failure, 2/38 (5.3%) instances of major bleeding, and 1/38 (2.6%) instances each of hemolysis, renal dysfunction, or device malfunction. Hospital admission occurred in 27/38 (71.1%) of visits, including 10/27 (37.0%) to a cardiac intensive care unit. No patients died during an ED visit or associated hospitalization. Mortality of all children in the outpatient VAD program during the study period was 3/30 (10.0%) including one patient on destination therapy, one with hemorrhagic stroke, and one with multi-system organ failure due to cardiogenic shock. In a single outpatient pediatric VAD program, patients had high utilization of ED care and had a high rate of hospital admission following ED presentation. The youngest patient transitioned to outpatient VAD care was 7 years old. Fever, abdominal pain/vomiting, and headache were the most frequent initial complaints. The most common adverse events were hypertension, major infection, and right heart failure.

Outpatient Management of Children With Complex Health Care Needs

Children with complex medical histories and acute and/or chronic health conditions may present under different circumstances and with different needs than their peers. This article uses examples to illustrate scenarios and related coding options for capturing the work of caring for children with complex health care needs.

Multicenter Evaluation of Emergency Department Treatment for Children and Adolescents With Crohn's Disease According to Race/Ethnicity and Insurance Payor Status.

Racial and socioeconomic disparities exist in the treatment and outcomes of children and adults with Crohn's disease (CD). This study investigated the impact of race and insurance status on emergency department (ED) evaluation and treatment among children with CD in the United States. Data from the Pediatric Health Information System included ED visits between January 2007 and December 2013 for patients aged ≤21 years with a primary diagnosis of CD, or a secondary diagnosis of CD plus a primary CD-related diagnosis. Analyses were performed using mixed-effects logistic regression. Subjects included 2618 unique patients (black, 612 [23%]; white, 2006 [77%]) with 3779 visits from 38 hospitals, a median age of 14.0 ± 4.0 years, and 50% male. White children had a higher median neighborhood income and were more likely to have private insurance (57% vs 30%; P < 0.001). Emergency department visits for privately insured patients had higher odds of complete blood count (odds ratio [OR], 1.43; 95% CI, 1.08-1.90) and C-reactive protein/erythrocyte sedimentation rate (OR, 1.39; 95% CI, 1.06-1.82) vs Medicaid insured. Visits for white children had higher odds of receiving antiemetics (OR, 1.52; 95% CI, 1.06-2.17) vs black children. The proportion of patients with repeat visits was greater for black children (33%) than white children (22%; P < 0.001) and greater for Medicaid-insured (27%) than privately insured patients (21%; P < 0.01). This cross-sectional database study demonstrated that black children and those with Medicaid insurance made more ED visits and received somewhat fewer treatments, which may be explained by greater use of the ED for routine care. An opportunity exists for better outpatient management of children with IBD so that nonemergent problems are more effectively handled.

Outpatient management of children at low risk for bacterial meningitis

ObjectiveTo determine the outcome of children aged 2–14 years with cerebrospinal fluid (CSF) pleocytosis and at very low risk for bacterial meningitis managed as outpatients without antibiotics.MethodsMulticentre, prospective, observational study...

Outpatient Management of Children With World Health Organization Chest Indrawing Pneumonia: Implementation Risks and Proposed Solutions.

This Viewpoints article details our recommendation for the World Health Organization Integrated Management of Childhood Illness guidelines to consider additional referral or daily monitoring criteria for children with chest indrawing pneumonia in low-resource settings. We review chest indrawing physiology in children and relate this to the risk of adverse pneumonia outcomes. We believe there is sufficient evidence to support referring or daily monitoring of children with chest indrawing pneumonia and signs of severe respiratory distress, oxygen saturation <93% (when not at high altitude), moderate malnutrition, or an unknown human immunodeficiency virus (HIV) status in an HIV-endemic setting. Pulse oximetry screening should be routine and performed at the earliest point in the patient care pathway as possible. If outpatient clinics lack capacity to conduct pulse oximetry, nutritional assessment, or HIV testing, then we recommend considering referral to complete the evaluation. When referral is not possible, careful daily monitoring should be performed.

Beta-lactam versus beta- lactam/macrolide therapy in pediatric outpatient pneumonia.

The objective was to evaluate the comparative effectiveness of beta-lactam monotherapy and beta- lactam/macrolide combination therapy in the outpatient management of children with community-acquired pneumonia (CAP). This retrospective cohort study included children, ages 1-18 years, with CAP diagnosed between January 1, 2008 and January 31, 2010 during outpatient management in the Geisinger Health System. The primary exposure was receipt of beta-lactam monotherapy or beta-lactam/macrolide combination therapy. The primary outcome was treatment failure, defined as a follow-up visit within 14 days of diagnosis resulting in a change in antibiotic therapy. Logistic regression within a propensity score- restricted cohort was used to estimate the likelihood of treatment failure. Of 717 children in the analytical cohort, 570 (79.4%) received beta-lactam monotherapy and 147 (20.1%) received combination therapy. Of those who received combination therapy 58.2% of children were under 6 years of age. Treatment failure occurred in 55 (7.7%) children, including in 8.1% of monotherapy recipients, and 6.1% of combination therapy recipients. Treatment failure rates were highest in children 6-18 years receiving monotherapy (12.9%) and lowest in children 6-18 years receiving combination therapy (4.0%). Children 6-18 years of age who received combination therapy were less likely to fail treatment than those who received beta-lactam monotherapy (propensity-adjusted odds ratio, 0.51; 95% confidence interval, 0.28, 0.95). Children 6-18 years of age who received beta- lactam/macrolide combination therapy for CAP in the outpatient setting had lower odds of treatment failure compared with those who received beta-lactam monotherapy.

The use of Exhaled Nitric Oxide (FeNO) in the Outpatient Management of Children with Asthma

The use of Exhaled Nitric Oxide (FeNO) in the Outpatient Management of Children with Asthma

Outpatient management of children with diabetes. Diabetes: don't immediately admit before evaluating the entire situation.

Outpatient management of children with diabetes. Diabetes: don't immediately admit before evaluating the entire situation.

Pediatric splenic injury: Pathway to play?

Background: Nonoperative management of blunt splenic injury (BSI) remains a “gold standard” in pediatric trauma care. Controversy exists regarding the minimal hospital stay necessary for the care of these patients and the appropriate duration of reduced activity required after discharge. Methods: A clinical pathway was developed in an attempt to standardize the hospital and outpatient management of children with BSI cared for at the Children's Hospital of Philadelphia. From July 1, 1996 to September 30, 1997, all children with BSI were treated using this pathway (pathway group). To better evaluate outcome, data were compared with an historical control of consecutive children treated at our institution during the previous 2 years (control group). Results: Twenty-eight children in the control group and 21 children in the pathway group comprise the study population. Average age, injury mechanism, grade of splenic injury, injury severity score, length of intensive care unit stay, and number of transfusions were not significantly different between the two groups ( P < .05). As expected, there was a significant decrease in the length of stay on the general carte units (5.3 ± 1.2 v 2.9 ± 0.9 days, control v pathway, P < .05), which, in turn, resulted in a significant decrease in the total length of hospitalization (6.7 ± 1.4 v 3.9 ± 1.2 days, P < .05) and estimated hospital charges. During follow-up, no complications or missed injuries were identified at a standard 3-week and the 3-month office visit. Conclusion: Hemodynamically stable children with isolated blunt splenic injuries may be treated safely with a 4-day hospital stay followed by 3 weeks of quiet activities at home and 3 months of light activity before return to full, unrestricted activity.

A controlled trial of nebulized aminoglycoside and oral flucloxacillin versus placebo in the outpatient management of children with cystic fibrosis

Six children with cystic fibrosis who had persistently had Pseudomonas aeruginosa isolated from their respiratory tract, completed a double-blind cross-over comparison of oral flucloxacillin and nebulized aminoglycoside versus double placebo. The patients had higher FEV 1 results at the end of the month of active treatment than after the month of placebo.

Optimal glucose control can be achieved in the young diabetic

Recent studies indicate that glucose control may be improved in adult diabetics with intensive insulin (II) Rx (using either infusion pumps or multiple injections) and home blood glucose monitoring. To examine the efficacy of these Rx strategies in children, we examined whether near normal glucose levels could be achieved in 8 young (age 10-15 yrs) diabetics given II Rx (6 pump, 2 multiple injections) for 2-6 mos. Control was assessed by HbA1 (nl 5-8%) and glucose measurements of blood samples mailed from home (HG). Glycemic excursions (MAGE) were determined from inpatient glucose profiles (IG). Effect of II Rx on glucose levels (mg/dl) is shown below (¶ p < 0.01).HbA1 levels fell significantly after 2 wks (12.7±1.0 to 9.3±0.7%) and was further reduced by 4-8 wks.(7.6±0.1%, p<0.005). Glycosuria was virtually eliminated (81±20 vs 3±1 gm/day).Insulin dose increased by 50% with II Rx (to 1.4 U/kg/day). However, hypoglycemia symptoms were mild and none required IV glucose. Conclusions: Near normal glucose control can be achieved in the outpatient management of children and adolescents with diabetes. The comparative efficacy of insulin pump vs multiple injections needs to be determined.