Group B streptococcal disease guideline

Group B Streptococcal Disease, Early-onset (Green-top Guideline No 36) | The Royal College of Obstetricians and Gynaecologists. 

Group B Streptococcal Disease (GBS) is recognised as the most frequent cause of severe early-onset infection in newborn infants. GBS is present in the bowel flora of 20–40% of adults (colonisation) and those who are colonised are called ‘carriers’. This includes pregnant women. There is variation in practice across the UK regarding the best strategies to prevent EOGBS disease.

In 2015, the incidence of EOGBS in the UK and Ireland was 0.57/1000 births (517 cases), a significant increase from the previous surveillance undertaken in 2000 where an incidence of 0.48/1000 was recorded.

The purpose of this guideline is to provide guidance for obstetricians, midwives and neonatologists on the prevention of early-onset (less than 7 days of age) neonatal group B streptococcal (EOGBS) disease and the information to be provided to women, their partners and families.

Group B Streptococcal Disease, Early-onset (Green-top Guideline No 36)

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The State of Child Health: Community paediatric workforce

New report, published the Royal College of Paediatrics and Child Health (RCPCH) and the British Association for Community Child Health (BACCH), highlights an alarming 25% shortfall in the number of community paediatricians.

The report raises concerns over the system failing to cope with growing demand and the unprecedented pressures faced by specialist community children’s doctors, who have a wide remit from child protection to managing children with disabilities and diagnosing those with conditions such as autism and ADHD.

The report makes a number of recommendations to turn the situation around. This includes an increase of 25% in the number of community paediatricians, equivalent to 320 more doctors, to meet recommended levels and reduce waiting times. It also provides extensive guidance and clear specifications for commissioners, clinicians and health care organisations, all with the aim of providing a high quality of care.

Download the State of Child Health: Community paediatric workforce

Read more about the RCPCH State of Child Health series

Fever in under 5s: assessment and initial management

New NICE guidance

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This guideline was updated in August 2017. It covers the assessment and early management of fever with no obvious cause in children aged under 5. It aims to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care.

Read full Clinical guideline [CG160] here

Seizure management in children requiring palliative care

Controlling seizures in children approaching death can be difficult, and there is a limited evidence base to guide best practice | BMJ Supportive & Palliative Care

Objectives: We compared current practice against the guidance for seizure management produced by the Association of Paediatric Palliative Medicine (APPM).

Methods: Retrospective case note review of episodes of challenging seizure management in children receiving end-of-life care over a 10-year period (2006–2015) in the south-west region of England.

Results: We reviewed 19 admissions, in 18 individuals. Six (33%) had a malignancy, nine (50%) had a progressive neurodegenerative condition and three (17%) had a static neurological condition with associated epilepsy. Thirteen (72%) died in their local hospice, four (22%) at home, and one (6%) in hospital. Seventeen of 19 episodes involved the use of subcutaneous or intravenous midazolam infusion, for a mean of 11 days (range 3–27). There was a wide range of starting doses of midazolam, and 9/17 (53%) received final doses in excess of current dose recommendations. Six individuals received subcutaneous phenobarbital infusions, with four of these (67%) receiving final doses in excess of current dose recommendations. Plans for adjustments of infusion rates, maximal doses or alternative approaches should treatment fail were inconsistent or absent. In 16/18 (88%) cases seizures were successfully controlled prior to the day of the child’s death. Staff found the experience of managing seizures at end of life challenging and stressful.

Conclusions: Pharmacological approaches to seizure management in end-of-life care are variable, often exceeding APPM dose recommendations. Despite this, safe and effective seizure control was possible in all settings.

Full reference: Harris, N. et al. (2017) Seizure management in children requiring palliative care: a review of current practice. BMJ Supportive & Palliative Care. Published Online First: 7th July 2017

Protection of Nurses Working with Children and Young People

Guidance to raise awareness among nurses and their managers of the complex issues surrounding safeguarding in the context of relationships between nurses and children and young people | RCN

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Image source: RCN

For the vast majority of nurses, harming those in their care, or even the possibility that another professional/colleague could, is the farthest thing from their minds. However, the RCN recognises that there are child abusers who target young people when they are at their most vulnerable. Abusers of children sometimes actively seek access to children by joining professions such as nursing, medicine, social work and teaching.

While in most identified cases, sexual abuse against children is carried out by men, it is important to recognise that women do it too. It is also important to keep things in perspective – the vast majority of nurses provide high standards in all aspects of caring for children and young people and protecting them from harm.

 

Physical activity in pregnancy

This infographic is the latest addition to a series commissioned by the UK Chief Medical Officers. It aims to provide clarity and consistency, and to equip health professionals to deliver evidence based recommendations on physical activity in pregnancy.

The aim is to ensure pregnant women are aware of the benefits of being active throughout their pregnancy and are clear about the physical activity recommendations. The infographic provides details regarding frequency, intensity and time, together with specific examples of suitable activities and key safety messages.

 

active pregnancy

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

National child measurement programme operational guidance

Guidance for local commissioners, providers and schools on running the national child measurement programme (NCMP) as part of the government’s commitment to tackling the public health challenge of excess weight.

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The publication of the Childhood Obesity Plan: A Plan for Action, in August 2016 shows that tackling child obesity is a priority for the Government. The plan aims to significantly reduce England’s rate of childhood obesity within the next ten years. Most local authorities have also identified addressing childhood obesity as a key issue in their health and wellbeing strategies, and reducing obesity is prioritised in many Sustainability and Transformation Plans.

The NCMP is key to monitoring the progress of the Government’s Childhood Obesity Plan. It provides the data for the Public Health Outcomes Framework indicators on “excess weight in children aged four to five years and ten to 11 years.” Because the data is valid at local level, it can also be used to inform the development and monitoring of local childhood obesity strategies.

 

National child measurement programme operational guidance

National child measurement programme: information for schools