Sydney Children's Hospitals Network Research Articles

The role of polysomnography in tracheostomy decannulation of the paediatric patient

IntroductionTracheostomy decannulation in the paediatric patient is usually considered when there is resolution or significant improvement in the original indication for the tracheostomy. The child's cardiorespiratory function needs to be optimized and assessment of the readiness for decannulation is generally by endoscopic evaluation to confirm airway patency and vocal cord mobility. Functional airway assessment procedures include downsizing the tracheostomy, adding fenestration, speaking valves and capping the tracheostomy tube.Few objective measures have been demonstrated to accurately predict the likelihood of successful decannulation. This study aims to evaluate the usefulness of polysomnography (PSG) with a capped tracheostomy tube, as an adjunct to airway endoscopy and traditional decannulation procedures, to predict decannulation outcome. MethodsA retrospective review was conducted for patients who underwent “capped” PSG prior to a trial of tracheostomy decannulation at the Sydney Children's Hospitals Network. The charts were reviewed for clinical data and PSG results. Results30 children with a total of 40 PSG reports were included in this study. There was a statistically significant difference in mean oxygen saturation, minimum oxygen saturation, total apnoea/hypopnoea index, desaturations >3%, and desaturations >3% index between those that had successful decannulation compared to failed decannulation. The measures with the greatest significance, and therefore, the best predictors of decannulation outcome were total apnoea/hypopnoea index (3.35events/h vs. 18.5events/h, p=0.004) and desaturation events (20.33 events vs. 192 events, p=0.001). ConclusionsPSG with a capped tracheostomy tube is a useful, objective tool to complement endoscopy and functional airway assessment in the consideration of decannulation in the paediatric population.

The Intensive Family & Adolescent Eating Disorders (IFAED) day program: a collaboration between Sydney Children's Hospital Network Eating Disorder Service and The Butterfly Foundation

The Sydney Children's Hospital Network Eating Disorder Service (EDS) at The Children's Hospital at Westmead (CHW) is a tertiary service that offers a range of family focused treatment options for young people with an eating disorder. The Intensive Family and Adolescent Eating Disorder (IFAED) Day Program is a new program that has been operating since September 2014, which targets young people and their families who have not been responding to standard treatment or who present with additional complexity. The IFAED program is designed as a treatment option that is more intensive than outpatient treatment, but less restrictive than overnight inpatient care. It operates five days per week and offers integrative and multidisciplinary care combining medical review, psychological treatment, meal support, secondary education and family support, including multiple family therapy. Theoretically, the program aims to strengthen and support families by increasing treatment intensity and solidarity to address barriers that are preventing progress. Interventions are provided for both families and young people. Underpinning the program is the belief that families are essential to recovery with weekly family therapy and parent groups enabling the family to be more responsive to the young person's behavioural and emotional needs. Group therapy for the young people targets skills to manage distress, improve flexible thinking, explore adolescent issues and improve communication skills. These interventions aim to improve coping and help the family support to be more effective. This presentation will outline the current IFAED Day Program structure and content, theoretical underpinnings and some preliminary outcome data.

CareTrack Kids—part 3. Adverse events in children's healthcare in Australia: study protocol for a retrospective medical record review

IntroductionA high-quality health system should deliver care that is free from harm. Few large-scale studies of adverse events have been undertaken in children's healthcare internationally, and none in Australia. The...

CareTrack Kids—part 1. Assessing the appropriateness of healthcare delivered to Australian children: study protocol for clinical indicator development

IntroductionDespite the widespread availability of clinical guidelines, considerable gaps remain between the care that is recommended (appropriate care) and the care provided. This protocol describes a research methodology to develop...

CareTrack Kids—part 2. Assessing the appropriateness of the healthcare delivered to Australian children: study protocol for a retrospective medical record review

IntroductionAustralian and international clinical practice guidelines are available for common paediatric conditions. Yet there is evidence that there are substantial variations between the guidelines, recommendations (appropriate care) and the care...

Exploring carer perceptions of training in out-of-hospital use of buccal midazolam for emergency management of seizures (2008-2012).

This study aims to explore carer perceptions of training in out-of-hospital use of buccal midazolam for emergency management of seizures. A random sample of 100 families (from n = 198) who underwent training at the Sydney Children's Hospitals Network, Randwick campus (2008-2012) were invited to participate in a telephone questionnaire. Sixty-three carers participated. Thirty-three children were female, median age at training was 4 years and seizure onset 2.75 years. Seizures were generalised in 26 children and focal in 37. Common reasons for prescription included history of prolonged seizures (38%), recent diagnosis of epilepsy (33%) and overseas travel (11%). Ninety-eight per cent of carers reported that training instructions were clear, and 94% reported the risks of using benzodiazepines were satisfactorily explained. Ninety per cent felt confident to administer the drug following training and 62% completed first aid training as recommended. Suggestions for improvement included follow-up/review and additional demonstration/practice. Twenty-one carers (33%) reported giving buccal midazolam a median five times, 67% reported it was effective in terminating the seizure and 71% called an ambulance as instructed. Problems reported in administration included excessive secretions and difficulties drawing up the solution. One child experienced breathing difficulties requiring oxygen by the paramedics. Four children were admitted to children's intensive care unit with status epilepticus requiring intubation. Training for out-of-hospital use of buccal midazolam was considered valuable by carers. Only a third of the sample subsequently used midazolam. Half of these carers reported problems in administration and one reported respiratory difficulty. These results highlight the importance of drug safety and efficacious training programmes.

‘Beyond Milestones’: A randomised controlled trial evaluating an innovative digital resource teaching quality observation of normal child development

The study aimed to create and evaluate the educational effectiveness of a digital resource instructing paediatric trainees in a systematic approach to critical and quality observation of normal child development. A digital educational resource was developed utilising the skills of an expert developmental paediatrician who was videoed assessing normal early child development at a series of critical stages. Videos illustrated aspects of language, sophistication of play and socialisation, cognition, and motor progress. Expert commentary, teaching text and summaries were used. A randomised controlled trial evaluated the resource. Paediatric trainees were recruited from The Sydney Children's Hospitals Network. Outcome measures were repeated at three time points (pre-teaching, immediate-post and 1 month) and included self-rated attitudes, knowledge of markers of development and observational expertise. Qualitative data on teaching usefulness were obtained through open-ended questions. Fifty-six paediatric trainees (registrar 79%, women 82%; mean age 31 years) completed the pre-assessment, 46 the immediate-post and 45 the 1-month follow-up (20% attrition). Compared with the Control group, the Teaching group scored higher over time on markers of development (P = 0.006), observational expertise (P < 0.0001), confidence (P = 0.035) and satisfaction (P < 0.0001). Teaching participants valued the video and expert commentary and reported improvement in confidence and understanding and acquiring a more structured approach. The 'Beyond Milestones' free online resource for medical professionals <http://learnpaediatrics.org/beyondmilestones/ password=cunningham> improves knowledge, increases confidence and is useful, providing a structured approach to developmental assessment. The techniques taught can be applied to every paediatric consultation.