Early management of paediatric burn injuries

Gill, P. & Falder, S. Paediatrics and Child Health | Published online: 21 April 2017

B0006880 Skin cells from a scald

Image source: Anne Weston, LRI, CRUK – Wellcome Images // CC BY-NC-ND 4.0

Image shows skin cells from a scald

Burns are a common form of trauma in children, resulting most frequently from scalds but also contact, flame, electrical and chemical sources. Burn patients have a wide spectrum of injury severity and diverse outcome, ranging from superficial burns with no lasting physical signs to deep, large body surface area burns which are profoundly life-changing, affecting all physiological systems. Size, site and depth are important factors affecting treatment and outcome.

There are important anatomical, physiological and psychosocial differences between adults and children. Their body proportions are different, they have thinner skin, smaller airways, reduced blood volume and high levels of distress. They are vulnerable to non-accidental injury.

Children require formal fluid resuscitation and maintenance fluids for burns more than 10% total body surface area. Complications include infection, toxic shock syndrome, adverse scarring and psychological sequelae. This paper discusses how correct assessment and management in the acute stage can reduce later morbidity and mortality.

Read the full abstract here

Transport of the critically ill child

Sarfatti, A. & Ramnarayan, P. Paediatrics and Child Health | Published online: 5 March 2017

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With the centralization of specialist services into a limited number of hospitals across the UK, an increasing number of children require an inter-hospital transfer. In 2014, 6000 critically ill or injured children were transferred between hospitals in the UK. While most of the transfers are done by specialist teams, as many as 23% are done by non-specialist teams.

These patients are some of the sickest children. It is while in transit that these patients are most at risk, and the transferring team is most exposed. To achieve a smooth and safe transfer it is important that the appropriate team with the relevant skills undertakes such transfers. The patient’s condition should be optimised before transfer and any likely difficulties are anticipated, and that the transferring team is prepared to act to resolve any complications swiftly and effectively. In this review we will attempt to offer our approach to the safe transfer of the critically ill child.

Read the abstract here

Delirium in Critically Ill Children

Traube, Chani et. al. Delirium in Critically Ill Children: An International Point Prevalence Study.
Critical Care Medicine. published online ahead of print January 10th 2017

Objectives: To determine prevalence of delirium in critically ill children and explore associated risk factors.

Design: Multi-institutional point prevalence study.

Setting: Twenty-five pediatric critical care units in the United States, the Netherlands, New Zealand, Australia, and Saudi Arabia.

Patients: All children admitted to the pediatric critical care units on designated study days (n = 994).

Intervention: Children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the bedside nurse. Demographic and treatment-related variables were collected.

Measurements and Main Results: Primary study outcome measure was prevalence of delirium. In 159 children, a final determination of mental status could not be ascertained. Of the 835 remaining subjects, 25% screened positive for delirium, 13% were classified as comatose, and 62% were delirium-free and coma-free. Delirium prevalence rates varied significantly with reason for ICU admission, with highest delirium rates found in children admitted with an infectious or inflammatory disorder. For children who were in the PICU for 6 or more days, delirium prevalence rate was 38%. In a multivariate model, risk factors independently associated with development of delirium included age less than 2 years, mechanical ventilation, benzodiazepines, narcotics, use of physical restraints, and exposure to vasopressors and antiepileptics.

Conclusions: Delirium is a prevalent complication of critical illness in children, with identifiable risk factors. Further multi-institutional, longitudinal studies are required to investigate effect of delirium on long-term outcomes and possible preventive and treatment measures. Universal delirium screening is practical and can be implemented in pediatric critical care units.

New blood draw protocol could minimize risk for critically ill children

Checklist-style guidelines decreased unnecessary blood culture collection by nearly half in study

Investigators say that safely reducing the frequency of blood draws in hospitalized children with fevers has historically not been a hospital priority despite the stress, pain and high rate of false positives associated with the procedure.

The researchers found that fostering cross-departmental collaboration and offering guidelines to clinicians helped reduce the number of unnecessary blood draws on some of the smallest and most vulnerable patients at the Johns Hopkins Children’s Center. Clinicians were able to accomplish an immediate reduction in unnecessary blood draws using the newly designed checklist protocols, and they were able to sustain the reduction over time.

Read the full overview here

Read the original research abstract here

Supporting Siblings of Neonatal Intensive Care Unit Patients

Morrison, A. & Gullón-Riveraemail, A.L. Journal of Pediatric Nursing. Published online: December 12 2016

life-862967_960_720.jpgHighlights:

  • The article discusses the benefit of a Social Story™ to support siblings as an intervention approach within the NICU.
  • The Social Story™ approach is unique and differs from the formats of current children’s books about NICU.
  • This article provides an example of a NICU Social Story™ ready to implement with siblings of NICU patients.
  • Child Life Specialists can utilize Social Stories™ as educational tool to provide sibling and family support.

Read the abstract here

Newborn Individualized Developmental Care and Assessment Program Reduces Length of Stay

Moody, C. et al. Journal of Pediatric Nursing. Published online: 3 December 2016

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Infants born at ≤32 weeks gestation are at risk of developmental delays. Review of the literature indicates NIDCAP improves parental satisfaction, minimizes developmental delays, and decreases length of stay, thus reducing cost of hospitalization.

Highlights:

  • NIDCAP is a proven framework for providing developmentally supportive care in the NICU, and can mitigate risks of prematurity
  • Earlier initiation of NIDCAP led to discharge at a younger post-menstrual age
  • Quality improvement investigations are effective in addressing critical healthcare needs

Read the full abstract here

Prevention of Catheter-Associated Bloodstream Infections in a Pediatric ICU

Düzkaya, D.S. et al. (2016) Critical Care Nurse. 36(6) pp. e1-e7

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Background: Bloodstream infections related to use of catheters are associated with increased morbidity and mortality rates, prolonged hospital lengths of stay, and increased medical costs.

Conclusions: Use of chlorhexidine-impregnated dressings reduced rates of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in a pediatric intensive care unit but was not significantly better than use of standard dressings.

Read the full abstract here