Infection prevention and control in the paediatric setting: the challenges

Winzor, G. & Cooke, R.P.D. Journal of Hospital Infection. Published online: 27 July 2016
Infection prevention and control (IPC) practices within the paediatric setting pose many unique challenges which are often linked to a lack of paediatric specific research. The short report in this issue of the JHI by Araujo da Silva et al1 highlights a lack of quality studies and practice recommendations for paediatric IPC.
Read the abstract here

Recognising factitious and induced illness in children

Zeitlin, S. Paediatrics and Child Health. Published online: 27 July 2016

Whilst it is unusual for carers to deliberately make a child ill, misrepresenting symptoms and even falsifying signs of disease is more common. The recognition that fabricated or induced illness (FII) is occurring usually emerges over time. It is rarely if ever a single event but rather an evolving pattern. Children of both sexes and all ages can be harmed in this way however, younger children and those who have had previous significant medical conditions appear to be more vulnerable. Whilst carers might have emotional and mental health needs seeking to understand their psychopathology may detract from addressing the impact on the child. In order to protect children from harm it is important for paediatricians to be aware of this condition and be alert to warning signs seen in clinical practice. This article aims to give an overview of FII and describes some clinical cases and the red flags that can prevent cycles of over investigation and potential harm to children

Read the abstract here

Treatment of Meningococcal Disease

Nadel, S. Journal of Adolescent Health. Volume 59(2). pp. S21-S28

Abstract

Image shows a positive test result for meningitis using the ultrasound enhanced diagnostic test

Meningococcal disease is a life-threatening infection that may progress rapidly, even after appropriate treatment has commenced. Early suspicion of the diagnosis is vital so that parenteral antibiotic treatment can be administered as soon as possible to reduce the complications of infection. The outcome of meningococcal disease is critically dependent on prompt recognition of two important complications: shock and raised intracranial pressure. Rapid recognition of disease and of these complications, together with appropriate management is crucial to the outcome of affected patients. This article summarizes the clinical features of invasive meningococcal disease, diagnostic tools, treatment modalities, and common post-infection sequelae.

Read the full article here

Journal of Pediatric Health Care – TOC July/August 2016

July/August issue includes:

JoPHC

Image source: JoPHC

  • NAPNAP 2016 Annual Conference Poster Award Winners and Presentation Abstracts
  • Associations Between Sleep and Health-Risk Behaviors in a Rural Adolescent Population
  • DSM-V Changes for Autism Spectrum Disorder (ASD): Implications for Diagnosis, Management, and Care Coordination for Children With ASDs
  • Missed Medical Appointments and Disease Control in Children With Type 1 Diabetes

View the full table of contents here

‘We urgently need kinder treatments for children’ – Noemi and Zofeya’s story

Cancer Research UK. Published online: 25 July 2016

When she was 4 years old, Zofeya was diagnosed with medulloblastoma, a type of brain tumour. Now 7, Zofeya lives with her parents Noemi and Matthew, and brother Malacai, in Bedfordshire.

Here, Noemi shares her daughter’s story – one of several that feature in the CRUK Annual Review, which highlights the progress we’ve made this year.

Read the full blog post here

Selecting children for head CT following head injury

Kemp, A. et al. Archives of Disease in Childhood.  Published Online: 22 July 2016

11534-2

Objective: Indicators for head CT scan defined by the 2007 National Institute for Health and Care Excellence (NICE) guidelines were analysed to identify CT uptake, influential variables and yield.

 

Main outcome measures: Number of children who had CT, extent to which NICE guidelines were followed and diagnostic yield.

Results: Data on 5700 children were returned by 90% of eligible hospitals, 84% of whom were admitted to a general hospital. CT scans were performed on 30.4% of children (1734), with a higher diagnostic yield in infants (56.5% (144/255)) than children aged 1 to 14 years (26.5% (391/1476)). Overall, only 40.4% (984 of 2437 children) fulfilling at least one of the four NICE criteria for CT actually underwent one. These children were much less likely to receive CT if admitted to a general hospital than to a specialist centre (OR 0.52 (95% CI 0.45 to 0.59)); there was considerable variation between healthcare regions. When indicated, children >3 years were much more likely to have CT than those <3 years (OR 2.35 (95% CI 2.08 to 2.65)).

Conclusion: Compliance with guidelines and diagnostic yield was variable across age groups, the type of hospital and region where children were admitted. With this pattern of clinical practice the risks of both missing intracranial injury and overuse of CT are considerable.

Read the full article here

Acceptance of Shaken Baby Syndrome and Abusive Head Trauma as Medical Diagnoses

Narang, S.K. et al. The Journal of Pediatrics. Published online: 22 July 2016

Objective: To assess the current general acceptance within the medical community of shaken baby syndrome (SBS), abusive head trauma (AHT), and several alternative explanations for findings commonly seen in abused children.

Study design: This was a survey of physicians frequently involved in the evaluation of injured children at 10 leading children’s hospitals. Physicians were asked to estimate the likelihood that subdural hematoma, severe retinal hemorrhages, and coma or death would result from several proposed mechanisms.

Results: Of the 1378 physicians surveyed, 682 (49.5%) responded, and 628 were included in the final sample. A large majority of respondents felt that shaking with or without impact would be likely or highly likely to result in subdural hematoma, severe retinal hemorrhages, and coma or death, and that none of the alternative theories except motor vehicle collision would result in these 3 findings. SBS and AHT were comsidered valid diagnoses by 88% and 93% of the respondents, respectively.

Conclusions: Our empirical data confirm that SBS and AHT are still generally accepted by physicians who frequently encounter suspected child abuse cases, and are considered likely sources of subdural hematoma, severe retinal hemorrhages, and coma or death in young children. Other than a high-velocity motor vehicle collision, no alternative theories of causation for these findings are generally accepted.

Read the abstract here