Ultrasound for children with abdominal trauma

Despite evidence showing that the routine use of sonography in hospital emergency departments can safely improve care for adults when evaluating for possible abdominal trauma injuries, researchers at UC Davis Medical Center could not identify any significant improvements in care for pediatric trauma patients | ScienceDaily

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The findings, which resulted from a randomized clinical study involving 925 children with blunt torso trauma who were evaluated in the emergency department at the medical center, showed no difference in important clinical outcomes. The outcomes assessed were developed for the study mainly based on previous research in injured adults.

The UC Davis team investigated the Focused Assessment with Sonography for Trauma (FAST) to determine whether the use of the FAST examination could safely lead to a decrease in the use of computed tomography (CT) scans for children, and other outcomes. FAST is a bedside ultrasound examination using a portable ultrasound machine. It has not been routinely used in the initial emergency department evaluations of injured children. CT scans represent the “gold standard” in diagnostic imaging for clinicians, including the identification of intra-abdominal injuries, but they also pose a greater radiation risk for children than they do for adults.

Retrospective cohort study of all deaths among infants born between 22 and 27 completed weeks of gestation

The aim of this research is to assess causes and circumstances of deaths in extremely low gestational age neonates (ELGANs) born in Switzerland over a 3-year period | BMJ Open

Design: Population-based, retrospective cohort study.

Setting: All nine level III perinatal centres (neonatal intensive care units (NICUs) and affiliated obstetrical services) in Switzerland.

Patients: ELGANs with a gestational age (GA) <28 weeks who died between 1 July 2012 and 30 June 2015.

Results: A total of 594 deaths were recorded with 280 (47%) stillbirths and 314 (53%) deaths after live birth. Of the latter, 185 (59%) occurred in the delivery room and 129 (41%) following admission to an NICU. Most liveborn infants dying in the delivery room had a GA ≤24 weeks and died following primary non-intervention. In contrast, NICU deaths occurred following unrestricted life support regardless of GA. End-of-life decision-making and redirection of care were based on medical futility and anticipated poor quality of life in 69% and 28% of patients, respectively. Most infants were extubated before death (87%).

Conclusions: In Switzerland, most deaths among infants born at less than 24 weeks of gestation occurred in the delivery room. In contrast, most deaths of ELGANs with a GA ≥24 weeks were observed following unrestricted provisional intensive care, end-of-life decision-making and redirection of care in the NICU regardless of the degree of immaturity.

Full reference: Berger, T.M. et al. (2017) Retrospective cohort study of all deaths among infants born between 22 and 27 completed weeks of gestation in Switzerland over a 3-year period. BMJ Open. 7:e015179

Women’s Smoking Status at Time of Delivery

This report presents the latest results and trends from the women’s smoking status at time of delivery (SATOD) data collection in England. 

The results provide a measure of the prevalence of smoking among pregnant women at Commissioning Region, Region and Clinical Commissioning Group level.

Key facts

In 2016/17:

  • 10.5 per cent of pregnant women were known to be smokers at the time of delivery. This compares to 10.6 per cent for the previous year (2015/16), and is down from 15.1 per cent in 2006/07.
  • This is the second consecutive year that the proportion has been below the national ambition of 11 per cent.
  • The CCGs with the lowest proportion of women known to be smokers at the time of delivery were NHS West London (2.3 per cent), NHS Richmond (2.5) and NHS Hammersmith and Fulham (2.7).
  • The CCGs with the highest proportion were NHS Blackpool (28.1 per cent), NHS Hull (22.9) and NHS North East Lincolnshire (22.3).
  • 104 out of 209 CCGs met the national ambition of 11 per cent or less.

The report can be viewed here

Preventing tooth decay in children under five

This professional resource from Public Health England outlines how health professionals, councils and partners can help prevent tooth decay in children under 5 as part of ensuring every child has the best start in life.

The guidance covers the following areas:

  • Scale of the problem
  • Risk factors for tooth decay
  • How to prevent tooth decay
  • Effective interventions for improving dental health
Preventing decay

Image Source: http://www.gov.uk

The role of nurses’ clinical impression in the first assessment of children at the emergency department

This study explores the diagnostic value and determinants of nurses’ clinical impression for the recognition of children with a serious illness on presentation to the emergency department (ED) | Archives of Disease in Childhood

Main outcome measures: Diagnostic accuracy of nurses’ clinical impression for the prediction of serious illness, defined by intensive care unit (ICU) and hospital admission. Determinants of nurses’ impression that a child appeared ill.

Results: Nurses considered a total of 1279 (20.0%) children appearing ill. Sensitivity of nurses’ clinical impression for the recognition of patients requiring ICU admission was 0.70 (95% CI 0.62 to 0.76) and specificity was 0.81 (95% CI 0.80 to 0.82). Sensitivity for hospital admission was 0.48 (95% CI 0.45 to 0.51) and specificity was 0.88 (95% CI 0.87 to 0.88). When adjusted for age, gender, triage urgency and abnormal vital signs, nurses’ impression remained significantly associated with ICU (OR 4.54; 95% CI 3.09 to 6.66) and hospital admission (OR 4.00; 95% CI 3.40 to 4.69). Ill appearance was positively associated with triage urgency, fever and abnormal vital signs and negatively with self-referral and presentation outside of office hours.

Conclusion: The overall clinical impression of experienced nurses at the ED is on its own, not an accurate predictor of serious illness in children, but provides additional information above some well-established and objective predictors of illness severity.

Full reference: Zachariasse, J.M. et al. (2017)  The role of nurses’ clinical impression in the first assessment of children at the emergency department. Archives of Disease in Childhood. Published Online First: 10 June 2017

Eggs can significantly increase growth in young children

Eggs significantly increased growth and reduced stunting by 47 percent in young children, finds a new study from a leading expert on child nutrition | ScienceDaily

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Eggs significantly increased growth and reduced stunting by 47 percent in young children, finds a new study from a leading expert on child nutrition at the Brown School at Washington University in St. Louis. This was a much greater effect than had been shown in previous studies.

Eggs were shown to increase standardized length-for-age score and weight-for-age score. Models indicated a reduced prevalence of stunting by 47 percent and underweight by 74 percent. Children in the treatment group had higher dietary intakes of eggs and reduced intake of sugar-sweetened foods compared to control.

Lithium Use in Pregnancy and the Risk of Cardiac Malformations

There has been concern that exposure to lithium early in pregnancy may be associated with a marked increase in the risk of Ebstein’s anomaly (a right ventricular outflow tract obstruction defect) in infants and overall congenital cardiac defects, but data are conflicting and limited | NEJM

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Image source: Erin – Flickr // CC BY-NC-ND 2.0

Methods: We conducted a cohort study involving 1,325,563 pregnancies in women who were enrolled in Medicaid and who delivered a live-born infant between 2000 and 2010. We examined the risk of cardiac malformations among infants exposed to lithium during the first trimester as compared with unexposed infants and, in secondary analyses, with infants exposed to another commonly used mood stabilizer, lamotrigine. Risk ratios and 95% confidence intervals were estimated with control for psychiatric and medical conditions, medications, and other potential confounders.

Conclusions: Maternal use of lithium during the first trimester was associated with an increased risk of cardiac malformations, including Ebstein’s anomaly; the magnitude of this effect was smaller than had been previously postulated

Full reference: Patorno, E. et al. (2017) Lithium Use in Pregnancy and the Risk of Cardiac Malformations. New England Journal of Medicine. 376 pp. 2245-2254