Pediatric Surgical Ward Research Articles

Predictors of Morbidity and Mortality of Gastrointestinal Perforation in Children

Background: Gastrointestinal perforation is a common surgical problem in paediatric surgical ward in our country. It carries a high morbidity and mortality in children. The predictors of postoperative morbidity and mortality are still not well established. Objectives: The objective of this study was to identify the predictors of morbidity and mortality following surgery for gastrointestinal perforation in children. Methods: This was a single centre cross sectional type of descriptive observational study carried out in the Department of Paediatric Surgery, Mymensingh Medical College Hospital with 16-month duration from 1st January, 2017 to April 30, 2018, in children aged from 2-12 years. Predictors related to postoperative morbidity and mortality were investigated. Results: A total of 40 patients were selected for this study with mean age of 8.92±2.61 years. Male: female was 1.5:1. Analysis indicated that factors associated with postoperative morbidity and mortality were low BMI, poor nutritional status, low serum total protein and albumin, delay in seeking treatment and contaminated peritoneal collection. Appendicular perforation was the highest number perforation in 23(57.5%) patients. Ileal perforation was the second highest number 8(20%). Appendectomy was the highest surgical procedure 21(52.5%), followed by resection-anastomosis and wound excision & repair 3(7.5%) each. Serum total protein and albumin were below normal limit among 15(37.5%) and 35(87.5%) patients respectively. 13(32.5%) patients received treatment 72 hours after onset of symptom and 18(45%) patients undergone operation within 24-48 hours of admission. Postoperative complications developed in 30 patients. Among them SSI were in 20(66.66%), SIRS in 9(30%) and leakage of repair in 1(3.33%) patient. Mortality rate was 5%. Conclusion: Poor nutritional status, low total serum protein and albumin, delay in initiation of treatment, and contaminated peritoneal fluid are the predictors of morbidity and mortality of gastrointestinal perforation in children.

A Randomized Controlled Trial Comparing Polyethylene Glycol with Sodium Phosphate for Gut Preparation in children undergoing Proctoscopy

Background: The outcome of diagnostic and therapeutic procedures such as proctoscopy, colonoscopy, and endoscopy relies on thorough bowel preparation, ensuring a complete view of the colonic mucosa. Aim: To compare polyethylene glycol with sodium phosphate for gut preparation in children undergoing proctoscopy. Methods: We conducted a study on pediatric patients aged 3 to 14 years who underwent elective proctoscopy. The study took place in the pediatric surgical ward of Mayo Hospital, Lahore, following approval from the hospital's Ethical Committee. We educated the parents or guardians of patients preoperatively about the use of bowl preparatory agents, their effectiveness, outcomes, side effects, complications, and informed consent. We divided the children into two groups to determine the method of bowl preparation. Patients in Group 'A' underwent bowl preparation using polyethylene glycol. Results: There were 60 patients, with 30 in each group. Patients in Group 'A' were given bowl preparation with polyethylene glycol. Before the proctoscopy, the patients underwent a 1-day PEG 3350 bowel preparation regimen. While group B had bowel preparation with sodium phosphate enema, the patients' mean ages were 4.46 years. In group A, there were 16 males and 14 females, while in group B, there were 19 males and 11 females. In group A, 11 patients demonstrated excellent compliance, 12 showed partial compliance, and 7 showed poor compliance with polyethylene glycol. While in group B, 22 patients showed excellent compliance, and 8 patients showed good compliance. Practical Implication: The study suggests that both polyethylene glycol (PEG) and sodium phosphate enema are suitable for pediatric patients undergoing proctoscopy. However, compliance rates vary between the two methods. Patients in group A showed varying levels of compliance, while those in group B showed higher compliance. Therefore, healthcare providers should consider sodium phosphate enema for improved patient adherence and procedural outcomes. This highlights the importance of assessing compliance rates for informed decision-making. Conclusion: In our experience, sodium phosphate enema was superior to oral polyethylene glycol in terms of compliance and adequacy of gut preparation. There were also fewer side effects with the sodium phosphate enema. Keywords: Polyethylene glycol, proctoscopy, gut preparation

A Randomized Controlled Trial Comparing Injection Polidocanol, with Injection 50% D/W in Rectal Prolapse

Background: Rectal prolapse manifests as the protrusion of the rectal mucosa through the anal opening. There can be partial or full thickness prolapse. It usually occurs before 4 years of age. Rectal prolapse in childhood tends to affect both males and females equally. Aim: To compare Inj. Polidocanol with Inj 50% D/W in rectal prolapsed in this randomized controlled trial. Methods: The study was conducted in the pediatric surgical ward of Mayo Hospital & King Edward Medical University Lahore, after receiving approval from the Hospital's Ethical Committee. There were 60 patients rectal prolapse with 30 patients in each group. Polidocanol was used in group A while 50%dextrose water was used in group B. The procedure was performed under general anesthesia. In the postoperative period children were observed for early complications like fever, anaphylaxis, diarrhea, hemorrhage, pain while defecating, mucosal edema and constipation. Results were analyzed with SPSS. Results: Out of 60, 36 were male while 24 were female. Group A included 16 male and 14 females whereas group B had 20 males and 10 female children. Mean age was 5.35years with SD of 2.7 and ranging from youngest child of 8 months till eldest of 12 years. In group A mean age was 5.44 while mean age of group B was 5.26 years. All 30 patients in group A were relieved of their symptoms after single session of Polidocanol so giving 100% of success rate while 28 patients (93.33%) in group B were relieved of their symptoms while 2(6.66%) patients developed recurrence with no significant difference. The complications observed in the study were post-operative constipation in 3(10%) patients in group A, however no patient developed postoperative stricture, infection or adverse drug reaction. In group B no patient developed any post-operative complication. Practical Implication: This comparative study helps us to find more effective and better drug available as a sclerosing agent to treat rectal prolapse in pediatric population. It’s also cost effective and with fewer side effects and easily available. Conclusion: In conclusion, injection sclerotherapy using polidocanol emerges as an equally successful procedure for managing RP in children. This medication demonstrates enhanced efficacy, safety, and accessibility. The process is not only less time-consuming but also entails minimal complications. Keywords: Rectal Prolapse Manifests, Protrusion, Mucosa, Chronic Constipation, Hirschsprung’s Disease,

Very low HIV positivity on paediatric surgical wards in Mozambique: Implications for inpatient provider-initiated testing programmes.

Very low HIV positivity on paediatric surgical wards in Mozambique: Implications for inpatient provider-initiated testing programmes.

Pediatric vital signs monitoring in hospital wards: Recognition systems and factors influencing nurses' attitudes and practices

AimsTo describe: 1) systems in place for recognition and response to deteriorating children in Italy, 2) attitudes and practices of registered nurses (RN) towards vital signs (VS) monitoring in pediatric wards, 3) the associations of nurses attitudes and pratices with nurses' and organizational characteristics. Design and methodsA multicentre cross-sectional correlational study. Data were collected between January–May 2020 using: an adapted version of the ‘Survey on Recognition and Response Systems in Australia’, and the ‘Ped-V Scale’. Descriptive and adjusted linear regression analysis was performed, accounting for clustering. ResultsTen Italian hospitals participated, 432 RNs responded to the Ped-V scale (response rate = 52%). Five (50%) hospitals had a VS policy in place, three hospitals (30%) had a Pediatric Early Warning System (PEWS), almost all hospitals had a system in place to respond to deteriorating children. Following multivariate regression analysis, having a PEWS was significantly associated with Ped-V scale ‘Workload’, ‘Clinical competence’, ‘Standardization’ dimensions; gender was associated with ‘key indicators’ and pediatric surgical ward with ‘Clinical competence’. ConclusionsThe use of VS policies and PEWS was not consistent across hospitals caring for children in Italy. Nurses' attitudes and practices (i.e., perception of workload, and clinical competence) were significantly lower in hospitals with increased complexity of care/PEWS. Gender was significantly associated with knowledge scores. Practice implicationsSystem strategies to improve nurses' attitudes and practices towards VS monitoring and education are warranted to support effective behaviors towards VS monitoring, their interpretation, and appropriate communication to activate the efferent limb of the rapid response system.

Epidemiology and early bacterial colonization of minor and moderate pediatric burns: A retrospective study from a developing country

ObjectivesInfection is still the leading cause of morbidity and mortality among burn patients worldwide. Isolation and identification of pediatric burn wound bacterial colonizers can prevent infection and improve burn trauma treatment. In this study, we explored early microbial colonizers within the burn wounds and the susceptibility of those isolates to antibiotics among hospitalized pediatric patients with minor and moderate burns, clinically significant infections and outcomes. MethodsA retrospective analysis of pediatric patients admitted to the inpatient pediatric surgical ward and treated for minor and moderate burns from 2009 to 2018 was performed. ResultsOne hundred six patients met the inclusion criteria. The mean age was 3.6 ± three years (0.2–14.1 years). The most common type of burn was scald burns (82.1%). The mean TBSA of the hospitalized pediatric burn cases was 8.5% (IQR, 6–12%). Seventy-nine (74.5%) patients had positive wound cultures at admission, regardless of the hospital admission day. Fifty-eight (73.4%) had one bacterial growth (mono isolate), while 21 (26.6%) had mixed growth or poly isolates. Among patients with mixed growth or poly isolate, 16 had two bacteria, three had three bacteria, and one had four bacteria isolated, totaling 105 isolated microorganisms (14 different species, 70.5% Gram-positive bacteria and 29.5% Gram-negative bacteria). Twelve patients (11%) developed clinically significant infections (eleven got burn wound infection, and one had septicemia). All patients received prophylactic systemic antibiotics. Only 35.2% of the isolated bacteria from the wounds were sensitive to the prophylactic antibiotics, and only ∼17% in case of clinically significant infections. We found a statistically significant difference in the length of hospital stay between patients with initially colonized samples of burn wounds compared with patients with initial negative samples (p = 0.008). All patients in the cohort survived hospital discharge. ConclusionDespite common bacterial colonization of acute burn wounds, only ∼10% of the patients developed clinically significant infections, a minority of which were sensitive to prophylactic antibiotics. Our findings indicate the need to refine the antibiotic approach in pediatric patients with minor/moderate burns in our local setting.

Comparison of analgesic efficacy of ultrasound-guided quadratus lumborum block versus erector spinae plane block in children undergoing elective open pyeloplasty - A randomized, double-blinded, controlled study.

Comparison of analgesic efficacy of ultrasound-guided transmuscular quadratus lumborum block (QL-3) and erector spinae block (ESP) in children undergoing open pyeloplasty was done in this study. This was a randomized, double-blinded, controlled study conducted in a tertiary care center, operating rooms, post-anesthesia care unit (PACU), and paediatric surgical ward. Sixty children of age 1-6 years, with American Society of Anesthesiologists (ASA) status I or II, undergoing elective open pyeloplasty were included in the study. Patients were randomized into two groups: group I (QL block-3) and group II (ESP). Both blocks were performed under USG guidance using 0.5 ml/kg of 0.25% ropivacaine after induction of general anesthesia. Postoperative Modified Objective Pain Score (MOPS), perioperative hemodynamic parameters, perioperative time for first rescue analgesia, total rescue analgesia, and incidence of complications were recorded. Statistical tests were applied as follows: (i) quantitative variables were compared using independent t-test/Mann-Whitney test (when the data sets were not normally distributed) between the two groups, and repeated measure analysis of variance (ANOVA)/Friedman test was used for comparison between different time intervals within the same group and (ii) qualitative variables were correlated using the Chi-square test/Fisher's exact test. A P value of <0.05 was considered statistically significant. Pain was assessed using MOPS in the postoperative period at 0, 30 min, 1, 2, 4, 6, 12, and 24 h. Overall, the pain scores were low and showed a decreasing trend toward baseline as time progressed. Group I showed lower score, but was statistically significant only at the sixth hour. Highest mean score was 2.4 ± 2.01 in group I and 2.67 ± 2.32 in group II. Perioperative hemodynamic parameters were comparable. Total rescue analgesia during the perioperative period was not statistically significant (intraoperative P = 0.075 and postoperative P = 0.928). Also, 63.33% patients in group I and 63% patients in group II required rescue analgesia in the postoperative period and were comparable. Mean ± standard deviation (SD) for first rescue analgesia time was 6.32 ± 12.57 in group I and 16.67 ± 31.25 in group II, but not significant. The distribution in group II was skewed, hence the larger value for group II, but when compared to group I, this was statistically not significant. Both ultrasound-guided ESP block and QL block using 0.25% ropivacaine 0.5 ml/kg provided adequate analgesia during the first 24 h post-surgery in children undergoing open pyeloplasty. The fentanyl requirement during the first 24-h postoperative period was also decreased.

Burden and Risk Factors of Contrast-Associated Acute Kidney Injury in Hospitalized Zambian Children: A Prospective Cohort Study at the University Teaching Hospitals.

Contrast-associated acute kidney injury (CAAKI) is defined as acute kidney injury (AKI) occurring within 72 hours of administration of contrast media (CM) and is linked to adverse outcomes including longer hospital stay, increased hospital mortality, and a higher risk of chronic kidney disease in later life. Risk factors for the development of CAAKI in the Zambian pediatric population have not been well studied. The objective of this study was to assess the burden of CAAKI, ascertain its risk factors, and describe short-term outcomes in hospitalized children at the University Teaching Hospitals (UTH) undergoing contrast-enhanced radiological investigations. This was a prospective observational study of in-patients undergoing contrast-enhanced radiological procedures, between September 2020 and September 2021. The participants were recruited from the Children's Hospital, the Cancer Diseases Hospital, and the Pediatric Surgical Ward at the University Teaching Hospital in Lusaka, Zambia. The primary outcome variable was occurrence of AKI at 48 hours post CM administration. We used 2 criteria to define CAAKI in our study-the European Society of Urogenital Radiology (ESUR) and the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Multivariable logistic regression models were formulated to assess for risk factors of CAAKI. Of the 201 enrolled participants, 123 (61.2%) were male and the median age of the participants was 5 years (interquartile range [IQR] = 3-10). The mean hemoglobin was 103 g/L (standard deviation [SD] = 26), median creatinine was 30.9 µmol/l (IQR = 22.6-43), and the glomerular filtration rate (GFR) was 102.5 mL/min/1.73 m2 (IQR = 76.2-129.4). Forty-six (22.9%) developed CAAKI using the ESUR compared with 4.5% (9/201) using the KDIGO criteria. Independent risk factors of CAAKI were receiving a higher dose of CM (adjusted odds ratio [aOR] = 2.54; 95% confidence interval [CI] = [1.12-5.74]), prematurity (aOR = 4.6; 95% CI = [1.05-16.7]), and a higher eGFR (aOR= 1.01; 95% CI = [1.01-1.02]). Females had higher odds of CAAKI (aOR = 2.48; 95% CI = [1.18-5.18]) when compared with males. One CAAKI participant (2.2%) died; none of the participants who developed CAAKI and survived required dialysis and most of them (90%) were discharged before day 7. Day 7 eGFR results had returned to or near baseline values for those whose creatinine results were available. Using the ESUR criteria, a significant proportion (22.9%) of children undergoing contrast-enhanced computed tomography (CT) scans at the UTH developed CAAKI. In contrast, using the KDIGO criteria only 4.5% had CAAKI. Being born as a preterm baby, being female, having a higher eGFR at baseline, and receiving a higher dose of CM were found to be independent risk factors for CAAKI development in Zambian children. Most of the cases of CAAKI in children were transient and of little clinical significance as only a minority of patients developing CAAKI required kidney replacement therapy and all resolved by day 7 post administration of CM.

Quality Improvement in Pediatric Surgical Ward Rounds after Implementation of Checklist.

Using checklists has been common in high-risk industries such as aviation, space, and maritime sectors. It is routinely being used in health care also. Daily ward rounds play an essential role in patient care. Missing key details in rounds are common. Sometimes, these medical errors can lead to adverse events or mismanagement of patients. A checklist was introduced for daily ward rounds in our newly established institution. This study aims to assess the improvement in the documentation. A checklist for ward rounds was introduced in September 2018. During the study period, between July 2017 and January 2020, 30 random case records for each of the two groups were taken. Group A (without checklist) and Group B (checklist) were compared to see the documentation of patient identification, diagnosis, operative status, fresh complaints, vitals, examination findings, charting treatment, catheters/drains/intravenous access, and urinary status/bowel movements. Sixty case records were included in the study. Comparison of documentation between Group A and Group B showed a significant difference in patient identification (50% vs. 100%), diagnosis (47% vs. 100%), operative status (33% vs. 100%), fresh complaints (76% vs. 100%), vitals (63% vs. 100%), examination findings (43% vs. 100%), charting treatment (73% vs. 100%), catheters/drains/intravenous access (10% vs. 86%), and urinary status/bowel movements (30% vs. 100%). Using checklists for daily ward rounds improves documentation. It reduces the gap in communication and potential errors in patient management.

Perforated appendicitis in infancy

Acute appendicitis is the major indication for abdominal surgery in the pediatric population. It represents 1–2% of all patients admitted into pediatric surgical wards. The clinical manifestations are varied and sometimes atypical due to the nature of the differing pathophysiology and the communicative capabilities of the patients based on age and development. We share a case of acute appendicitis that first presented to our emergency department and admitted under general pediatric medicine; later surgically treated and confirmed using histopathology. The patient's health record was reviewed for the following: demographics, visits, imaging modalities, management, outcome, and histopathology. Our 2-month-old patient was admitted under the general pediatric team who treated him at first under the assumption of incomplete Kawasaki disease. A consultation to pediatric surgery for an infected urachus lead to an Ultrasound and CT-scan studies being done. This was followed by exploratory laparotomy and appendectomy due to the need for drainage and further assessment. The findings which were further confirmed by histopathological specimens were suggestive of acute appendicitis with peri-appendiceal abscess Acute appendicitis in infants is a challenging diagnosis, A high level of suspicion and having knowledge of the red flags specific to abdominal pain and appendicitis in infants could significantly aid in improving diagnostic skills. In addition, early imaging using US in addition to CT is paramount in insuring early recognition and optimal outcomes

Assessment of Nurses Knowledge Related to Nursing Documentation at Pediatric Surgical Wards

Objectives: The aim of this study is to assess nurse's knowledge about nursing documentation at pediatric surgical wards. Methodology: Using pre- and post-tests for one set of pediatric surgery ward nurses in Baghdad, this study is the core component of a larger study that used a descriptive study design to fulfill the study objectives. Between December 23, 2021, and July 20, 2022, researchers conducted the study. There were three tests: baseline, post-test 1, and post-test 2 in the study group. Results: During pre-test time they show poor levels among all items of the scale. During the post-test 1 and 2, the nurses show good level of knowledge about concept of nursing documentation (Total mean score = 0.86 and 0.77) in which the mean scores show good level among all items of this domain. Conclusion: Nurses has poor knowledge regarding nursing documentation at pediatric surgical wards. There is an association between nurses' knowledge and their (gender, level of education, years of experience and main source of information. Recommendations: Further research is imperative, that will pay more attention to the accuracy of nursing documentation, factors leading to variation in practice, flaws in nursing documentation quality and the effects of these on nursing practice and pediatric patient outcomes.

Impact of an Intervention Program on Nurses Knowledge towards Infection Control Measures in Pediatric Surgical Wards

Background: Infection control has become a major concern in the health-care system, and health-care personnel, especially nurses, are particularly vulnerable to infection. The goal of this study is to see how effective an intervention program is in improving nurses' knowledge of infection prevention in pediatric surgery wards. Methods: A pretest–posttest quasi-experimental design was used in this investigation. There were 40 people in the sample. Twenty nurses from the Central Teaching Hospital of Pediatrics were in the intervention group, whereas twenty nurses from the Children Welfare Teaching Hospital were in the control group. The questionnaire's dependability was established through a pilot research, and it was subsequently presented to experts for validation. The total number of items in the knowledge section of the questionnaire was 35. The information was gathered through self-reporting and analyzed using descriptive and inferential statistical data analysis. Results: The study's findings revealed that (80%) of nurses had inadequate knowledge, while (70%) of nurses had adequate knowledge after implementing the intervention program. In the pre-test period of assessment, there is no statistically significant difference between the intervention and control groups (p>0.05). At the post-test measurement period, there is a statistically significant difference between the intervention and control groups (p0.05). Conclusions: Nurses' awareness of infection control procedures can be improved through an intervention training program. The nurses' understanding of infection control was improved following the training, according to the findings of this study. This study found that the training program is very effective, and that all nurses should be exposed to infection control training in order to provide them with the knowledge and skills they need to combat illness spread in the health-care context.

Effectiveness of an Instructional Program for Nurses' About Nursing Documentation at Pediatric Surgical Wards

Objectives: Evaluate the effectiveness of the instructional program for nurse's knowledge's about nursing documentation at pediatric surgical wards. Study design: A quasi-experimental design was implemented in the research to achieve the study goals by using pre- and post-tests for one group of nurses in pediatric surgical wards. in Baghdad city. The study has been carried out during the period extended from the 23th december 2021 to 20th July 2022. Data collection: It was done at three times: baseline data (before any instruction was provided to the study group), then post-test 1 after 21 days of starting to give the instructional program (in the study group), and post-test 2 after 2 months of starting to give the instructional program. Conclusion: Illustrated from this study, the nurses have poor knowledge regarding nursing documentation at pediatric surgical wards at pretest in study group. Association between nurses' knowledge and their (gender, level of education, years of experience and main source of information. Recommendations: Recommendations were made based on findings. for further research is imperative, that will pay more attention to the accuracy of nursing documentation, factors leading to variation in practice, flaws in nursing documentation quality and the effects of these on nursing practice and pediatric patient outcomes. Keywords: nurses, nursing documentation, pediatric surgical wards.

Effective of an Intervention Program on Nurses Practices Concerning Infection Control Measures in Pediatric Surgical Wards

Background: Infection control has become a major concern in the health-care system, and health-care personnel, especially nurses, are particularly vulnerable to infection. The goal of this study is to see how effective an intervention program is in changing nurses' practices in pediatric surgery wards when it comes to infection management. Methods: This study used a quasi-experimental design for the pre- and post-test. The sample consisted of 40 persons. The intervention group included twenty nurses from the primary pediatric teaching hospital, while the control group included twenty nurses from the pediatric care teaching hospital. The questionnaire's dependability was proven through empirical study, and it was then submitted to specialists for validation. The total number of items in the questionnaire was 49. Self-reports were used to collect data, which was then evaluated using descriptive and inferential statistical data analysis. Results: According to the findings, 70% of nurses had insufficient practices before implementing the intervention program, while 60% of nurses had adequate practices after implementing the program. In the pre-test period of assessment, there is no statistically significant difference between the intervention and control groups (p&gt;0.05). At the post-test measurement period, there is a statistically significant difference between the intervention and control groups (p0.05). Conclusions: In order to improve nurses' infection control practices, an interventional training program is essential. The findings of this study revealed that after receiving training, nurses' infection control practices improved. This study found that the training program is highly successful, and that all nurses should receive infection control training to gain the information and skills necessary to prevent infection in a hospital context. Health-care executives should recognize the importance of establishing rules to improve nurse working conditions and offer the required training to guarantee infection-control strategies are implemented. Keywords: Intervention Program, Practices, Nurses.

Prevalence of burns in children 0 to 14 years admitted into Paediatric surgical ward of Murtala Muhammad Specialist hospital Kano-Nigeria

&lt;em&gt;&lt;strong&gt;Background:&lt;/strong&gt; Burns internally, means an injury due to either fire or chemical on the human. In fact burn injury is a major public health problem and leading cause of childhood mobility and mortality world Wide. About 60% of all burn patient suffers from burn of intermediate severity corresponding to less than 10% of the body surface these patients can be treated as our parents. The objectives of the study are (a) To determine the age and gender group that has the highest occurrence of burns from Jan 2019 to Jan 2020 in patient admitted into paediatric surgical ward of Murtala Muhammad Specialist Hospital Kano. (b) To Identify the possible causes of paediatric burns in Paediatric surgical ward of Murtala Muhammad Specialist hospital Kano. (c) Identify the number of children with burns from January 2019 to January 2020. &lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study designed and census sampling technique was used were all the patients with burns were record.&lt;strong&gt; Results: &lt;/strong&gt;The study shows that children aged 2 – 5 years have the highest occurrence of burns.Also Males have the highest prevalence within these months with about 58.6% compared to females. The most common cause of domestic paediatric burns admitted in Murtala Muhammad Specialist Hospital from January 2019 – January 2020 is fire and flame burn injury.the study also revealed that 87 children ranges from 0 – 14 years admitted with cases of domestic burns during the period of the study at Murtala Muhammad Specialist Hospital Kano.&lt;strong&gt; Conclusion: &lt;/strong&gt;In the research, it is seen that burns are accidents damage to skin cause by heat, flame, chemical, electricity and radiation. Risk factors of burns include: gender, age, occupation that increase exposure to fire, easy access to chemical e.t.c. therefore, proper health education should be introduced especially to mothers and caregivers who do not have knowledge of the causes and preventive measures.&lt;/em&gt;

Multicentre point-prevalence survey of antibiotic use and healthcare-associated infections in Ethiopian hospitals

ObjectiveEffective antimicrobial containment strategies such as Antimicrobial Stewardship Programs (ASPs) require comprehensive data on antibiotics use which are scarce in Ethiopia. This study sought to assess antibiotics use and healthcare-associated...

Assess the effectiveness of predesigned instructions for caregivers of children undergoing surgery on post operative outcomes at selected hospitals of Ambala, Haryana: A quasi experimental study

Background: Preoperative education is to not only prepare the child for their surgery, but also to reduce the risk of post-operative complications from occurring. Objectives: To Assess and compare the post operative outcomes of the children undergoing surgery after administration of predesigned instructions in comparison and experimental group, and to find out the association of post operative outcomes with selected variables in comparison and experimental group. Design: Quasi-Experimental research design “Non equivalent control group post test - only design was used. Participants: Data was collected from 30 caregivers of children undergoing surgery (15 in each group) by convenience sampling technique. Setting: Pediatric Surgical ward of Maharishi Markandeshwar Institute of Medical Sciences and Research Hospital, Mullana, Ambala, Haryana. Respiratory assessment scale & wound assessment scale were used to collect data. Result: The mean post operative respiratory score of children was comparatively less in the experimental group (day 1- 6.47±0.91 & day 4 - 6.40 ±0.63) as compared to the comparison group (day 1- 6.93±1.58 & day 4 - 6.47 ±0.74) and the mean wound status score in experimental group (day 3- 7.80±1.52) whereas in comparison group (day 3 - 8.20±2.21) was found to be non significant at 0.05 level of significance. Significant association of post operative respiratory status and wound status of children with selected demographic variables. Conclusion: Predesigned Instructions were effective for Caregivers of Children Undergoing Surgery in improving post operative outcomes of children and caregivers.

Management and Outcome of Acute Appendicitis in Pediatrics; Our Experience at Queen Rania Al Abdullah Hospital for Children

Objectives: the purpose of our study was to report our experience at Queen Rania Al Abdullah Hospital for Children (QRHC) in the diagnosis and management of acute appendicitis regarding the outcome, complications and hospital stay. Method: A retrospective study was carried out at QRHC by reviewing the medical records of patients who were younger than 14 years that admitted to pediatric surgical ward in the period from Jan 2019 to Jan 2020 with a diagnosis of acute appendicitis. The study included 196 patients, 116 were males and 80 were females with a male to female ratio of 1.45:1. The ages of the patients ranged from 3 years to 14 years with the highest incidence between 10 -13 years. The duration of symptoms ranged from 8 hours to 1 week. The period of hospital stay ranged from 1 to 8 days with a median stay of 2 days. Results: all patients underwent appendectomy, 120 via open approach and 76 by laparoscopy with only 1.53% conversion rate to open (3 cases). 110 cases (56.1%) were non complicated appendicitis while the remaining 86 cases (43.9%) were complicated (perforated appendix), of those 20 cases were less than 5 years old. The rate of negative appendectomy (histopathological normal appendix) was 11.2% (22 cases). Fever was presented in 60 cases (30.6%) and leukocytosis was presented in 130 cases (66.3%).U/S was suggestive of acute appendicitis in 108 patients (55.1%) while the appendix was not visualized in the remaining 88 patients. CT scan was required in 40 patients (20.4%). The overall postoperative complications was 10.7% which occurred in 21 patients, 8 patients (4.1%) developed post-operative ileus , 6 patients (3.1%) complicated with wound infection, 4 cases (2%) developed intra-abdominal abscess and 3 patients (1.5%) had intestinal obstruction. Conclusion: Acute appendicitis is the commonest cause of abdominal surgical emergency in pediatrics and a common cause of misdiagnosed surgical emergency in children. Delayed diagnosis can result in ......

Antibiotic Use Among Hospitalized Children and Neonates in China: Results From Quarterly Point Prevalence Surveys in 2019.

Background: Antimicrobial resistance is a significant clinical problem in pediatric practice in China. Surveillance of antibiotic use is one of the cornerstones to assess the quality of antibiotic use and plan and assess the impact of antibiotic stewardship interventions. Methods: We carried out quarterly point prevalence surveys referring to WHO Methodology of Point Prevalence Survey in 16 Chinese general and children’s hospitals in 2019 to assess antibiotic use in pediatric inpatients based on the WHO AWaRe metrics and to detect potential problem areas. Data were retrieved via the hospital information systems on the second Monday of March, June, September and December. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions and ward types according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) Classification. Results: A total of 22,327 hospitalized children were sampled, of which 14,757 (66.1%) were prescribed ≥1 antibiotic. Among the 3,936 sampled neonates (≤1 month), 59.2% (n = 2,331) were prescribed ≥1 antibiotic. A high percentage of combination antibiotic therapy was observed in PICUs (78.5%), pediatric medical wards (68.1%) and surgical wards (65.2%). For hospitalized children prescribed ≥1 antibiotic, the most common diagnosis on admission were lower respiratory tract infections (43.2%, n = 6,379). WHO Watch group antibiotics accounted for 70.4% of prescriptions (n = 12,915). The most prescribed antibiotic ATC classes were third-generation cephalosporins (41.9%, n = 7,679), followed by penicillins/β-lactamase inhibitors (16.1%, n = 2,962), macrolides (12.1%, n = 2,214) and carbapenems (7.7%, n = 1,331). Conclusion: Based on these data, overuse of broad-spectrum Watch group antibiotics is common in Chinese pediatric inpatients. Specific interventions in the context of the national antimicrobial stewardship framework should aim to reduce the use of Watch antibiotics and routine surveillance of antibiotic use using WHO AWaRe metrics should be implemented.

909. Reassessing Pathogens Eligible for the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) “Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection” Criteria

BackgroundNHSN Mucosal Barrier Injury-Laboratory Confirmed Bloodstream Infection (MBI-LCBI) includes pathogens likely to cause bloodstream infections (BSI) in some oncology patients. MBI-LCBIs are excluded from central line-associated BSI (CLABSI) reporting to the Centers for Medicare & Medicaid Services. NHSN users have requested other pathogens be added to MBI-LCBI. To make decision, we compared CLABSI pathogen distributions in three NHSN patient location groups.MethodsWe analyzed CLABSI data from hospitals conducting surveillance for ≥ 1 month from January 2014–December 2018 in ≥ 1 MBI high-risk location (leukemia, lymphoma, and adult and pediatric hematopoietic stem cell transplant wards). We compared CLABSI pathogen distributions and rates in MBI high-risk locations to medium-risk (solid tumor, adult and pediatric general hematology-oncology wards) and low-risk locations (adult and pediatric medical, surgical, and medical-surgical wards), and used χ2 tests to compare percentages with statistical significance at P ≤ 0.05.ResultsOverall, 122 hospitals reported 23,578 CLABSIs and 12,961,921 central line (CL)-days (1.81 CLABSIs per 1,000 CL-days) (Table). Percentages of CLABSIs due to three MBI-LCBI pathogens (E. coli, E. faecium, Viridans streptococci) were significantly higher in high- versus low-risk locations, while for other MBI-LCBI pathogens (K. pneumoniae/oxytoca, E. faecalis, Candida spp., Enterobacter spp.) percentages were significantly lower in high-risk locations (Figure). For pathogens not currently in MBI-LCBI, coagulase-negative staphylococci caused similar percentages of CLABSIs across locations, S. aureus caused a significantly higher percentage of CLABSIs in low-risk locations, while PA caused a significantly higher percentage of CLABSIs in high-risk locations. Table CLABSIs attributed to MBI high-risk, medium-risk, and low-risk locations, NHSN, 2014–2018 Figure Percentages of top 10 pathogen-specific CLABSIs in MBI high-risk, medium-risk, and low-risk locations, NHSN, 2014–2018 ConclusionDifferences in percentages of CLABSIs due to selected pathogens between MBI high-risk and low-risk locations are evident in NHSN data. Lower percentages of Klebsiella and Candida spp. in high-risk locations might be partially due to antimicrobial prophylaxis in oncology patients. Although PA caused a significantly higher percentage of CLABSIs in high-risk locations, the absolute difference was modest. Additional analyses are needed.Disclosures All Authors: No reported disclosures