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PAEDIATRIC HOSPITAL PRACTICE – FREE PAPERS

THE TRAJECTORY TOWARDS CHRONIC KIDNEY DISEASE AMONG ABORIGINAL YOUNG PEOPLE: THE ARDAC STUDY

Kim S1,2, Hodson EM1,2, Daylight J1, Williams R1, Vukasin N1, Kearns R1, Lyle DM3 , Macaskill P2, Craig JC1,2

1Centre for Kidney Research, The Children's Hospital at Westmead, Australia

2Sydney School of Public Health University of Sydney, Australia

3Department of Rural Health, University of Sydney, Australia

Background: The gap in chronic disease between Aboriginal and non-Aboriginal people remains substantial. We aimed to determine whether the increased prevalence of chronic kidney disease (CKD) in Aboriginal adults becomes evident in adolescence through examining early markers of chronic disease.

Methods: A prospective cohort study of Aboriginal and non-Aboriginal school children commenced in 2002 across 15 different screening centres involving 38 primary schools and 213 high schools across urban, regional and remote NSW. We have collected data on haematuria, albuminuria, blood pressure and BMI every 2 years.

Results: 3418 (1949 Aboriginal) participants were screened with 11,387 patient years of follow up; 67% of participants attended follow up. The average age at enrolment was 10 years. At baseline, 31% of the cohort was either overweight or obese; a significantly greater proportion of Aboriginal participants were overweight or obese (33% versus 29%, P = 0.02). At baseline Aboriginal participants were more likely to have albuminuria (12.6% versus 10.1%, P = 0.03) and haematuria (6.9% versus 3.5%, P < 0.01). Overall risk factors for albuminuria were increasing age (adjusted odds ratio [AOR] increase by each year over 10 years: 1.17, 95% confidence intervals [CI] 1.14–1.19, P < 0.01) and female gender (AOR 1.73 95% CI 1.49–2.01, P < 0.001). Aboriginal participants were more likely to have albuminuria when overweight or obese compared with non-Aboriginal participants. Among Aboriginal and non-Aboriginal participants, being underweight presented a greater risk of developing either transient (AOR: 0.88, 95% CI 0.80–0.96) or persistent albuminuria (AOR 0.75, 95% CI 0.64 to 0.88).

Conclusion: Weight gain increases the risk of albuminuria for Aboriginal compared with non-Aboriginal participants. Under nutrition increases the risk of albuminuria in all participants. Community based screening of participants in the ARDAC study will continue to assess whether the risk for albuminuria changes during early adulthood.

PREDICTORS OF OUTCOME IN CHILDREN HOSPITALISED WITH PANDEMIC INFLUENZA IN 2009: A PROSPECTIVE NATIONAL STUDY

Gulam Khandaker1,2,12, Yvonne Zurynski1,4, Greta Ridley1,4, Jim Buttery5, Helen Marshall,6 Peter C Richmond FRACP,7 Jenny Royle MD,8 Michael Gold MD,9 Tony Walls FRACP,10 Bruce Whitehead,11 Peter McIntyre,2,3,12 Nicholas Wood,2,3 Robert Booy2,3,12 and Elizabeth J Elliott1,2,3,4,12

1The Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia,

2National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Sydney, New South Wales, Australia

3The Sydney Children's Hospitals Network (Westmead), Sydney, NSW, Australia

4The Australian Paediatric Surveillance Unit, Sydney, NSW, Australia

5Murdoch Children's Research Institute and Monash Children's Hospital, Department of Paediatrics, Monash University, Melbourne, Victoria, Australia,

6Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia,

7School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia,

8Immunisation Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia,

9School of Paediatrics and Reproductive Health, University of Adelaide, South Australia,

10Department of Paediatrics, University of Otago, Christchurch, New Zealand,

11Respiratory Medicine, John Hunter Children's Hospital, NSW, Australia,

12The Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), Sydney Medical School, the University of Sydney, Sydney, NSW, Australia

Background: Seasonal influenza is an important cause of hospital admission in children. The impact of the 2009 H1N1 pandemic posed enormous burden on paediatric hospital services.

Aims/Objectives: We aimed to describe the clinical epidemiology and examine predictors for adverse outcomes in children hospitalised in Australia with pandemic influenza.

Methods: Active hospital surveillance in 6 tertiary paediatric referral centres (June-September, 2009) for all children aged <15 years admitted with laboratory-confirmed pandemic influenza.

Findings: Of 601 children admitted with laboratory proven influenza, 506 (84.2%) had influenza A(H1N1)pdm09. Based on annual admissions to surveillance hospitals, the hospital admission rate for influenza was 33.9 per 1,000 admissions in 2009. Half (51%) the children with influenza A(H1N1)pdm09 were previously healthy. The mean length of hospital stay was 5.9 days. Rapid diagnosis decreased antibiotic use and length of hospital stay. Fifty (9.9%) children were admitted to paediatric intensive care (PICU), 30 (5.9%) required mechanical ventilation and 5 (0.9%) died. Laboratory proven bacterial co-infection and chronic lung disease were significant independent predictors of PICU admission (OR 6.89, 95% CI 3.15, 15.06 and OR 3.58, 95% CI: 1.41, 9.07 respectively) and requirement for ventilation (OR 5.61, 95% CI: 2.2, 14.28 and OR 5.18, 95% CI: 1.8, 14.86 respectively). Chronic neurological disease was a predictor of admission to PICU (OR 2.30, 95% CI: 1.14, 4.61).

Conclusions: During the 2009 pandemic, influenza was a major cause of hospitalisation in tertiary paediatric hospitals. Co-infection and underlying chronic disease increased risk of PICU admission and/or ventilation. Half the children admitted were previously healthy, supporting a role for universal seasonal influenza vaccination in children.

CAN CHILDREN WITH MODERATE TO SEVERE CELLULITIS BE EFFECTIVELY TREATED AT HOME WITH ONCE DAILY INTRAVENOUS ANTIBIOTICS?

Vicki Burneikis, Robert Parry

Central Coast Local Health District, New South Wales, Australia

Background: Although previous papers have shown that ambulatory management of moderate to severe cellulitis is possible with once daily intravenous (IV) antibiotics, failure rates were 9–21%, and there is no concensus on the most appropriate antibiotic regime1,2.

Aim: To document rates of complications and success or failure of ambulatory management, in all children (0–17 years) with cellulitis (excluding periorbital cellulitis) managed with IV antibiotics through ambulatory care at Gosford and Wyong hospitals between 1st January and 31st December 2013.

Method: Details of cases were collected prospectively during the study period, and electronic records were used to gather information regarding presentation, management and outcome. Failure of ambulatory management was defined as the need for hospital admission, and was the primary outcome measure. Secondary outcomes included need for change in antibiotic regime, complications, unplanned emergency attendance during treatment, and representation with a related diagnosis within one month.

Results: 30 cases were found, and of these 29 (97%) were successfully managed in the ambulatory care units, without admission. There were no unplanned attendances, and no patient represented within a month of diagnosis.

24 patients received daily IV ceftriaxone and flucloxacillin, plus oral flucloxacillin 6 hourly, 6 received daily IV ceftriaxone only, and 2 received daily IV cefazolin and 6 hourly oral probenecid. 3 patients (10%) required a change in antibiotic due to poor response after 48 hours, one (3%) required incision and drainage of an abscess, which was done under local anaesthesia in the ambulatory care unit.

Of the 3 regimes, patients treated with cefazolin and probenecid were significantly more likely to require a change in antibiotic regime (OR 8.0, 95% CI 5.4–9.6, p < 0.01), compared with those treated with ceftriaxone with or without flucloxacillin. Ceftriaxone alone appeared less successful than the combination of ceftriaxone and flucloxacillin, although results were not statistically significant.

Age was a significant risk factor for poor response at 48 hours, with 4 of 7 patients aged 12 or over needing to change antibiotic, compared with none of 23 younger patients (p < 0.05).

Conclusion: 97% of our moderate to severe cellulitis patients were successfully managed through ambulatory care without admission or recurrence.

References

1. Kam AJ et al, “Pediatric Cellulitis, Success of Emergency Department Short-Course Intravenous Antibiotics”, Ped Em Care 2010

2. Gouin S et al, “Prospective Evaluation of the Management of Moderate to Severe Cellulitis with Parenteral Antibiotics in a Paediatric Day Treatment Centre”, J Paed &Ch Health 2008

PAEDIATRIC DEPARTMENT NIGHT SHIFT AUDIT, CAMPBELLTOWN HOSPITAL, SW SYDNEY

Passarello L1, Vosu J1, Datta R2, Chin R2, Edwards M1, Marsh D2, Whitehall J1

1University of Western Sydney, New South Wales, Australia

2Campbelltown Hospital, New South Wales, Australia

Time and motion studies of paediatric junior staff are rare. Campbelltown Hospital is a busy peripheral hospital in Sydney with 24 paediatric and 16 special care neonatal beds (SCN), serving nearly 5000 paediatric hospitalisations, 3000 deliveries, and 5000 nocturnal ED attendances, annually. One paediatric registrar is rostered from 11.00 pm to 9.00 am to cover the wards and consult in ED to trainees of that specialty. Because of concerns of over-work it was decided to closely examine the registrar's activities.

Methods: For six weeks, the registrar was shadowed by one of two medical students who recorded each task (according to 14 definitions), its duration (five minute intervals) and location. Data was recorded by hand and entered in a spread sheet in the morning.

Results: 1,195 activities by five registrars were recorded over 264 hours. Percentage of time in each task is reported in Figure 1. The percentage of time spent in various locations is reported in Figure 2.

figure

Figure 1. Percentage of Time per Activity.

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figure

Figure 2. Percentage of Time per Location.

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Discussion: The time and motion study reveals total commitment by the registrar to patient care in three competing sites in different parts of the hospital at the same time. There were no rostered breaks. <5 min/shift was taken rest and ablutions. All registrars returned home fatigued in traffic.

HOW SAFE ARE OUR KIDS? IMPROVING THE SAFETY AND QUALITY OF PAEDIATRIC CARE IN AN AUSTRALIAN ADULT ACADEMIC HEALTH SERVICE

Lynch C1,2, Panozzo T1, Reeves J1

1Alfred Health, Victoria, Australia

2Monash Childrens Hospital, Victoria, Australia

Introduction: Care of children occurs in many adult health services. Alfred Health is a large adult health network with a surprisingly large number of paediatric presentations. It was apparent that there was no transparent organization approach to ensuring safe effective and age appropriate care was provided.

Method: Royal Australasian College of Physicians (RACP) and National Safety and Quality Health Service Standards (NSQHS) have documented standards of care for children in hospitals Paediatric specific data was collected to provide an overview of paediatric care. RACP Audit tools revealed areas where standards were not met. An organization wide Paediatric Governance Committee oversaw implementation of a series of recommendations. Improvement was needed in facilities, resources and specific paediatric education for staff. These included introduction of age specific Paediatric Graphic observation charts, paediatric medication chart, monthly clinical data sets to allow for service delivery audits

Results: RACP and NSQHS audit tools were used pre and post implementation. Significant improvements included purpose built paediatric amenities to minimize colocation of children with adults .A new paediatric model of care in the emergency department includes the use of age specific observation charts and clinical guidelines. Regular audits with specific paediatric focus now occur. There has been an increased reporting of actual or near miss clinical incidents. Graphic observation charts improved communication and allowed escalation of the deteriorating patient.

Conclusion: Paediatric patients cared for in predominantly adult health services are at risk without specialized and age specific systems of care. Accurate and meaningful data allows better understanding of service delivery. Executive sponsorship, multi service and multi disciplinary stakeholders are essential for change.

BIRTH THROUGH MECONIUM STAINED AMNIOTIC FLUID: DO ALL INFANTS REQUIRE 24 HOUR OBSERVATION IN HOSPITAL?

Gupta S, Birch P

Gold Coast University Hospital, Southport, Queensland, Australia

Background: Birth through meconium stained amniotic fluid (MSAF) can be associated with adverse neonatal outcomes leading many institutions to admit infants for a period of at least 24 hours of observation following birth.

Objective: To identify infants following birth through MSAF who would be at very low risk of requiring admission to the Newborn Care Unit (NCU) and would therefore be safe for early discharge at 6 hours of age.

Methods: This was a retrospective audit of term infants born through MSAF over an 11 month period from December2011 to November 2012

Results: 348 infants birthed through MSAF (111 per 1,000 live births). 2.6% of term infants born through MSAF developed meconium aspiration syndrome (MAS). 92.3% of term admissions following birth through MSAF occurred before 6 hours of age and no infant developed MAS beyond 6 hours of age. The development of MAS was associated with male gender (OR 8, 95% CI 66.7–1, p = 0.05), 5 minute Apgar score (5AS) < 9 (89% with MAS vs. 5% without MAS, p < 0.0001) and emergency caesarean section (40% with MAS vs. 11% without MAS, p < 0.0001). The 5AS was significantly lower in infants who developed MAS (6.3 vs. 8.9, p = 0.006). Having a 5AS ≥ 9 was strongly associated with not developing MAS (OR 0.007, CI 0.001–0.057, p < 0.0001) with 99.7% of 318 term infants who birthed through MSAF with a 5AS ≥ 9 not developing MAS.

Conclusion: Infants with 5AS ≥ 9 are unlikely to develop MAS and all infants with MAS developed symptoms within 6 hours of age. Rates of admission beyond 6 hours of age are low, therefore we conclude that for infants born through MSAF with a 5AS ≥ 9 it is safe for early discharge at 6 hours of age.

RUE WRIGHT MEMORIAL AWARD

INCREASED INCIDENCE OF PLEURAL EMPYEMA IN NEW ZEALAND CHILDREN: A RETROSPECTIVE REVIEW OF PAEDIATRIC EMPYEMA AND PARAPNEUMONIC EFFUSION IN SOUTH AUCKLAND 1998–2012

Mahon CD1, Walker W1, Best E2

1Kidz First Paediatric Department, Middlemore Hospital, South Auckland, New Zealand

2Department of Paediatric Infectious Diseases, Starship Children's Health, Auckland New Zealand

Background: Worldwide the incidence of childhood empyema has increased, speculated in part to be due to childhood pneumococcal vaccination programs selecting for certain non-vaccine serotypes. New Zealand introduced universal 7-valent pneumococcal vaccination (PCV-7) in mid-2008. South Auckland has high rates of paediatric respiratory morbidity.

Aims/Objectives: We aimed to establish the incidence of paediatric empyema prior to, and following PCV-7, and describe the epidemiology, clinical features, pathogens and outcomes of children with empyema and parapneumonic effusion (PPE) in South Auckland between1998 and 2012.

Methods: Children aged 0–15 years with discharge diagnoses of pleural effusion associated with pneumonia were retrospectively identified. Empyema was defined by ultrasound and pleural tap criteria. PPE PPE was defined as radiologic pneumonia with pleural fluid not meeting empyema criteria. Epidemiology, clinical features, microbiology and outcomes of empyema and PPE were compared and incidence rates over time analysed.

Findings: Of 187 cases identified, 104 met criteria for empyema with 83 cases classified as PPE. The incidence of empyema increased from 1/100,000 in 1998 to 10/100,000 in 2012, with a peak incidence of 13/100,000 in 2009. The incidence of PPE increased from 4/100,000 in 1998 to 6/100,000 in 2012. Staphylococcus aureus was most frequently isolated (n = 38), followed by Streptococcus pneumoniae (n = 31). Dominant S.pneumoniae serotypes were 1 and 14. Cases of S.aureus empyema increased 4 fold over the study period. 35% of empyema cases received pre-hospital antibiotics compared with 53% of PPE cases (p = 0.02). Children who received pre-hospital antibiotics were less likely to require surgical intervention (RR 0.57, CI 0.39-0.87).

Conclusions: Empyema incidence is increasing and this occurred prior to the introduction of PCV-7 in our population. S. aureus is the predominant causative organism in South Auckland children in contrast to S.pneumoniae reported in most other developed countries. The role of pre-hospital antibiotic prescribing in preventing the need for surgical intervention in empyema may be important in our population.

PILOT STUDY OF eADVICE (ELECTRONIC ADVICE AND DIAGNOSIS VIA THE INTERNET FOLLOWING COMPUTERISED EVALUATION)

Caldwell PHY1,2, Sureshkumar P2, Hamilton S2, Kerr M2, Lau A3, Craig JC1,2

1University of Sydney, New South Wales, Australia

2The Children's Hospital at Westmead (CHW), New South Wales, Australia

3University of NSW, New South Wales, Australia

Background: Waiting times for paediatric outpatient services are usually long, and is 24 months for the CHW continence service. Our research team have built a prototype interactive eHealth program/app (eADVICE) for managing paediatric incontinence, which can be accessed on the Internet and downloaded to a mobile device. This program follows an evidence-based algorithm for managing incontinence and transfers the exchange of information between the parents and specialists. It mimics multiple visits to a specialist paediatric continence service and combines assessment, diagnosis, tailored treatment advice, monitoring and feedback and well as education.

Aims: To assess the effects of an interactive eHealth for managing urinary incontinence in children awaiting a specialist appointment.

Methods: We conducted a pilot study of 10 children with urinary incontinence who used the eADVICE program for 4 months, supervised by their GP. We assessed whether the program provided the correct diagnosis and treatment advice, change in wetting from baseline, and adhered to the treatment advice given.

Results: The program was found to be accurate in assessing and providing appropriate treatment advice. Families visited the site an average of 3.2 times (range 2–6 visits) during the 4 months. 2 patients became completely dry, and another 2 improved using the program. However, up to 50% of treatment advice was not followed by families.

Conclusion: An interactive eHealth program is effective in providing tailored treatment advice for children. However, the poor adherence to eHealth advice needs to be addressed to improve the applicability of this methodology in clinical practice.

SPECIALIST HOME-BASED NURSING SERVICES FOR CHILDREN WITH ACUTE AND CHRONIC ILLNESSES (COCHRANE REVIEW)

Parab CS1, Cooper C2, Woolfenden S3, Piper SM4

1,4Illawarra Shoalhaven Local Health District, Wollongong, Australia

2Royal North Shore Hospital, St Leonards, Australia

3Sydney Children's Hospitals Network, Randwick, Australia

Introduction: This review aimed to evaluate specialist home based nursing services as these were proposed as a cost-effective means of reducing distress resulting from hospital admissions, while enhancing primary care and reducing length of hospital stay.

Methods: The databases were searched electronically for initial screening of study titles and abstracts. Full text articles of the selected studies were then reviewed. The search was carried out independently by study authors and disagreements were resolved by consensus.

Results: Screening of 4226 titles yielded seven RCTs with a total of 840 participants. Participants, interventions and outcomes were diverse, thus metanalysis was not conducted. No significant differences were reported in health outcomes and hospital re-admission rates. Two studies reported a reduction in the hospital stay (2.37 vs 1.37 days, p < 0.001 and 96.9 hours vs 55.2 hours, p = 0.001). Two studies identified greater parent and child satisfaction. One study reported better parental coping and functioning (p < 0.001). Two studies respectively revealed no difference in the impact of illness on the family or parental burden of care. In terms of costing, one study reported parental cost savings of CAD 188 per child (p < 0.001) and increased cost to the hospital of CAD 87 (p < 0.001) with another study reporting similar findings qualitatively. One study did not report any significant cost difference.

Conclusion: Limited evidence base for home care programs; however suggestive evidence for greater parental satisfaction, improved quality of life and a reduction in the length of hospital stay. The cost-effectiveness of these programs is still to be determined. Further trials with adequate sample sizes, standardised clinical outcome measures and comprehensive costing analysis are required.

WILEY NEW INVESTIGATOR AWARD

PAEDIATRIC PRESENTATIONS TO A NON-TERTIARY PAEDIATRIC HOSPITAL OVER A 12 MONTH PERIOD: IMPLICATIONS FOR WORKFORCE PLANNING

Hardy A,1 Fuller DG,1,2,5 Forrester M,1,2,5 Anderson PK,1,2,5 Cooper C,1,2,5 Jenner B,1,2,5 Marshall I,1,2,5 McCloskey K,1,2,5 Sanderson C,1,2,5 Standish J,1,2,5 Worth J1,2,5 and Vuillermin P (senior author)1,2,3,4,5

1Children's Services, Barwon Health, Geelong, Victoria, Australia

2Deakin University, Geelong, Victoria, Australia

3Murdoch Children's Research Unit, Victoria, Australia

4Child Health Research Unit, Barwon Health, Victoria, Australia

5St John of God Hospital, Geelong, Victoria, Australia

Introduction: Paediatricians working at non-tertiary hospitals have a substantial developmental and behavioural workload.1 Data regarding the burden and scope of acute care is limited.

The present study aims to determine, for paediatricians working in non-tertiary hospitals:

  • (1) 
    The volume and case mix of acute care paediatrics practised, and
  • (2) 
    Whether the volume and case mix has changed since the 1990s.

Methods: Over a 12 month period (December 2012 to December 2013), acute paediatric inpatient, emergency department (ED) and neonatal case mix was determined in the Barwon region, Victoria, Australia, by reviewing hospital database information. These data were compared to case mix data collected during 1996/1997.2

Results: Since 1996/1997, paediatric hospital admissions increased by 45% (95% confidence interval (CI) 38% to 52%; p < 0.0001) and presentations to the ED increased by 186% (95% CI 181% to 191%; p < 0.0001). A wide variety of problems are managed by paediatricians working in non-tertiary hospitals.

Conclusions: Paediatricians working in non-tertiary hospitals manage a diverse range of inpatients. General paediatric training and consultant paediatrician Continuing Medical Education programs should be designed to ensure the acquisition and maintenance of the knowledge and skills required to manage such patients. The significant increases in paediatric presentations to ED and paediatric admissions is relevant to workforce planning. If these trends continue, a greater number of general paediatricians with adequate acute care skills will be required to meet these needs.

References

1. Hewson P. A 12-month profile of community paediatric consultations in the Barwon region. Journal of Paediatrics and Child Health. 1999; 35: 1622

2. Hewson P et al. The evolving role of community-based general paediatricians: The Barwon experience. Journal of Paediatrics and Child Health. 1999; 35: 2327

PROCEDURAL AND RESUSCITATION REQUIREMENTS FOR PAEDIATRICIANS WORKING IN A NON-TERTIARY CENTRE: IMPLICATIONS FOR TRAINING

Hardy A,1 Fuller DG,1,2,5 Forrester M,1,2,5 Anderson PK,1,2,5 Cooper C,1,2,5 Jenner B,1,2,5 Marshall I,1,2,5 McCloskey K,1,2,5 Sanderson C,1,2,5 Standish J,1,2,5 Worth J1,2,5 and Vuillermin P (Senior Author)1,2,3,4,5

1Children's Services, Barwon Health, Geelong, Victoria, Australia

2Deakin University, Geelong, Victoria, Australia

3Murdoch Children's Research Unit, Victoria, Australia

4Child Health Research Unit, Barwon Health, Victoria, Australia

5St John of God Hospital, Geelong, Victoria, Australia

Introduction: Paediatricians working at non-tertiary hospitals are required to perform a variety of procedures and to lead paediatric resuscitations. Data regarding the scope of procedural skills required and the frequency with which procedural and resuscitation skills are utilised is required.

The present study aims to determine the procedural and resuscitation skills required by paediatricians working at non-tertiary hospitals and the frequency with which these skills are utilised.

Methods: Over a 12 month period (December 2012 to December 2013), each of the 11 paediatricians involved in acute inpatient care at the Geelong Hospital completed a weekly on-line survey regarding their inpatient clinical experience. This included procedures performed or directly supervised as well as their resuscitation involvement.

Results: Each of the 11 paediatricians who managed inpatients on a regular or semi-regular basis during the study period agreed to participate and each completed all of the weekly surveys. There were 7 Geelong Hospital paediatricians with an inpatient appointment (each with a 0.27 Full Time Equivalent (FTE) paediatrician workload) and 4 paediatricians providing inpatient cover on a locum basis. Apart from intravenous cannulation, paediatricians working in non-tertiary hospitals utilise procedural skills infrequently. Each 0.27 FTE paediatrician performed 0.86 intubations and was involved in 11.3 neonatal, 1.7 infant and 2.4 child resuscitations.

Conclusions: Paediatricians working at non-tertiary hospitals are required to perform and supervise critical procedural and resuscitation skills, but have limited opportunities to maintain proficiency in such skills. General paediatric training and consultant paediatrician Continuing Medical Education programs should be designed to ensure the acquisition and maintenance of the procedural and resuscitation skills required for the practice of non-tertiary acute care paediatrics.

MENSTRUAL MANAGEMENT FOR DEVELOPMENTALLY DELAYED GIRLS AT THE CHILDREN'S HOSPITAL WESTMEAD PAEDIATRIC AND ADOLESCENT GYNAECOLOGY OUTPATIENT CLINIC

Chuah I1, Mcrae A2, Steinbeck K2,3

1The Department of General Medicine, The Children's Hospital at Westmead, Sydney, Australia

2The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, Australia

3Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia

Introduction: Requests for assistance in menstrual management and menstrual suppression are a common, emotive and sometimes controversial aspect of disability care. Little has been published since the introduction of the levonorgestrel releasing intrauterine system (LG-IUS) has become available to the therapeutic armamentarium.

Methods: A retrospective review and detailed data collection from the medical records of all girls with physical and intellectual disability referred for menstrual management to the Paediatric and Adolescent Gynaecology clinic for the three year period between January 1, 2010 and January 1, 2013.

Results: Eighty girls were referred. A third (28) of girls were premenarchal at first review with caregivers seeking anticipatory advice. Of the post-menarchal girls the median age of menarche was 12 (range 10–15). Caregiver concerns of both groups were explored in detail, as were the menstrual characteristics of the post menarchal girls. We investigated the first line and second line interventions trialled and reasons for change.

Our population differ from similar previously published groups in the marked absence of the use of depot medroxyprogesterone acetate or the subdermal etonorgestrel-releasing device. The combined oral contraceptive pill (OCP) was the most often used therapy (67%) and 18 girls in total had a levonorgestrel releasing intrauterine system inserted (30%).

Conclusion: Premenarchal concerns are important to address as a paediatrician, it can be an opportunity to allay caregiver concerns and provide them with appropriate advice. Our study supports the use of the OCP as good first line management in achieving menstrual suppression. The LG-IUS appeared to be a satisfactory second line option. Further investigation into longer term outcomes and complications of the device insertion should be performed to determine its viability for the future.

P&CHD – Neonates

  1. Top of page
  2. P&CHD – Neonates
  3. P&CHD – Respiratory
  4. P&CHD – Neurology
  5. P&CHD/AMD – Infectious Diseases
  6. TBD: Obesity and Epigenetics, Diabetes and Endocrine AMD/PCHD

HIGH-FLOW NASAL CANNULAE FOR THE TREATMENT OF PRETERM INFANTS: WHAT IS THE EVIDENCE?

Brett Manley1,2

1Neonatal Services and Newborn Research Centre, The Royal Women's Hospital, Melbourne

2Department of Obstetrics and Gynaecology, The University of Melbourne

Heated and humidified high-flow nasal cannulae (HFNC) are being used to treat preterm infants in the majority of neonatal intensive care units (NICUs) in the USA, United Kingdom, and Australasia. Until recently, this practice was not supported by evidence from clinical trials, as shown by the 2011 Cochrane Review on the topic. In recent times, non-tertiary centres have also begun to treat newborn infants with HFNC.

This talk will cover the following:

  • The background to HFNC use in preterm infants and the proposed mechanisms of action of this therapy.

  • Clinical scenarios in which HFNC are being used to treat preterm infants, including:

    • post-extubation support

    • primary respiratory support after birth

    • ‘weaning’ infants from nasal CPAP

  • Results of clinical trials of HFNC, with particular emphasis on the three recently published randomised trials of HFNC vs. nasal CPAP in preterm infants:

    • Collins et al 2013

    • Yoder et al 2013

    • Manley et al 2013

  • Recommendations for HFNC use in NICUs, including:

    • important safety principles

    • safe and effective gas flows

    • evidence-based clinical indications

  • The use of HFNC in non-tertiary centres, including important factors to be considered when using non-invasive support in these centres

  • Trials of HFNC which are proposed or underway, including randomised trials of HFNC as primary support for preterm infants with early respiratory distress in NICUs and non-tertiary special care nurseries.

SURFING THE CPAP WAVE: MINIMALLY-INVASIVE SURFACTANT THERAPY IN PRETERM INFANTS WITH RDS

Dargaville, Peter

ABSTRACT NOT AVAILABLE AT THIS TIME

TBC

Malcolm Battin

ABSTRACT NOT AVAILABLE AT THIS TIME

ADOLESCENT AND YOUNG ADULT MEDICINE

Moloney, Susan

Gold Coast University Hospital, Australia

The RACP is currently applying to have recognition of Adolescence and Young Adult Medicine as a specialty in Australia and New Zealand. This will be an update and summary of the processes required to achieve this and thus allow entry into AYAM training.

THE SPECIALIST YOUTH HEALTH APPROACH

Bridget Farrant

Adolescence is a dynamic and exciting time of development with specific opportunities and challenges. Professionals working with young people need specific skills and approaches to help achieve the best outcomes for young people. Some young people and their families will need specialist youth health support. Some services working with young people and their families will need specialist youth health support for service development to assist clinicians in taking a developmentally appropriate approach when working with young people.

An adolescent and young adult medicine specialist is a generalist with specialist skills in working with young people.They have expertise in engaging with young people, helping identifying the needs and developing management plans within a youth development framework.

This presentation centres around a case of a young person with a chronic health condition who developed complicated and debilitating somatic symptoms. The challenge and opportunities of working with the young person, family and other professionals, and assisting in meeting this young person's developmental needs will be highlighted.

YOUTH HEALTH AND IDENTITY: LOOKING AFTER TRANSGENDER YOUNG PEOPLE

Denny, Simon – 1528

ABSTRACT NOT AVAILABLE AT THIS TIME

P&CHD – Respiratory

  1. Top of page
  2. P&CHD – Neonates
  3. P&CHD – Respiratory
  4. P&CHD – Neurology
  5. P&CHD/AMD – Infectious Diseases
  6. TBD: Obesity and Epigenetics, Diabetes and Endocrine AMD/PCHD

HYPERTONIC SALINE IN ACUTE VIRAL BRONCHIOLITIS

Julian Vyas

Starship Childrens Hospital, AUCKLAND, NZ

Acute viral bronchiolitis (AVB) is a significant cause of respiratory disease. The WHO estimates 150 million new cases p.a., of which 95% occur in developing countries. 7–11% of affected infants require hospital admission. Despite the ubquity of the disease, therapeutic intervention beyond simple supportive therapy has remained elusive. In 2002, published data from Israel reported a reduction in clinical severity score in children receiving 3% saline and terbutaline. This suggested that hypertonic saline may indeed be an intervention which modified the disease process in AVB; or at the very least might be a significant adjunct to the simpler, and more established, supportive therapies in use.

Understandably, clinical curiosity in the use of hypertonic saline in AVB has evolved. The findings of a 2008 Cochrane review (updated last year) acknowledged a possible role for hypertonic saline in AVB. At present its use is not endorsed as a routine standard of therapy in consensus guidelines published by a number of authoritative bodies (e.g. RCH, Melbourne; SIGN, UK; AAP).

This presentation will review the current understanding of airway epithelial pathology in AVB; possible mechanism of action of hypertonic saline solutions; evidence of clinical benefit; and possible risks from use of the therapy.

STEROIDS IN PRE-SCHOOL CHILDREN WITH ACUTE WHEEZE

Dalziel, Stuart

ABSTRACT NOT AVAILABLE AT THIS TIME

HIGH FLOW NASAL CANNULA, PHYSIOLOGICAL PRINCIPLES AND CLINICAL EVIDENCE

Schibler, Andreas

ABSTRACT NOT AVAILABLE AT THIS TIME

P&CHD – Neurology

  1. Top of page
  2. P&CHD – Neonates
  3. P&CHD – Respiratory
  4. P&CHD – Neurology
  5. P&CHD/AMD – Infectious Diseases
  6. TBD: Obesity and Epigenetics, Diabetes and Endocrine AMD/PCHD

NEW GENES IN FOCAL EPILEPSY

Lynette Sadleir

University of Otago, Wellington, New Zealand

The focal epilepsies which are the most common epilepsies have not traditionally been considered genetic in origin. Recent discoveries show that genes have a role to play in both familial and sporadic cases of focal epilepsy and are revealing opportunities for better diagnosis, prognostication, genetic counselling and potential therapies.

EARLY DETECTION OF CEREBRAL PALSY

Alicia Spittle1,2,3

1Murdoch Childrens Research Institute, Parkville, Victoria, Australia

2The University of Melbourne, Parkville, Victoria, Australia

3The Royal Women's Hospital, Parkville, Victoria, Australia

Cerebral Palsy (CP) is an umbrella term which “describes a group of disorders of the development of movement and posture, causing activity limitations, which are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain.”1 Despite CP being the most common physical disability in childhood, the majority of children with CP are not diagnosed early in infancy, with the average age of diagnosis in Australia recently reported from CP registers as 19 months of age. Early detection of CP is important not only for counselling families but also to ensure that intervention is commenced in a timely manner. Research has shown that delays in diagnosis of CP are associated with dissatisfaction and grief for families. Further, emerging evidence from the neuroplasticity literature suggest that intensive, repetitive, task-specific intervention for CP ought to commence very early while the brain is most plastic

Identifying children at risk of CP early in development has improved over the past decade with greater understanding of the predictive value of early motor assessments and brain imaging. General Movements Assessments, which involve observation of an infant's spontaneous movement patterns, have been shown consistently in systematic reviews of early detection of CP to be the most predictive.2 This presentation will provide an overview of the evidence for early detection of CP, with an emphasis on General Movements Assessments

1. Bax M, Goldstein M, Rosenbaum P, et al. Proposed definition and classification of cerebral palsy, April 2005. Developmental medicine and child neurology. Aug 2005;47(8):571576.

2. Spittle AJ, Doyle LW, Boyd RN. A systematic review of the clinimetric properties of neuromotor assessments for preterm infants during the first year of life. Developmental medicine and child neurology. Apr 2008;50(4):254266.

P&CHD/AMD – Infectious Diseases

  1. Top of page
  2. P&CHD – Neonates
  3. P&CHD – Respiratory
  4. P&CHD – Neurology
  5. P&CHD/AMD – Infectious Diseases
  6. TBD: Obesity and Epigenetics, Diabetes and Endocrine AMD/PCHD

TUBERCULOSIS. DIAGNOSIS AND CHALLENGES

Lesley Voss

Starship Children's Hospital, Auckland, New Zealand

Control of tuberculosis remains one of the millennium development goals with Stop TB Paternship and World Health Organisation establishing a target to reduce annual incidence to less than one case per million population by 2050. In Australia and New Zealand rates of TB have been stable or declining, both for adults and children, for many years with the large burden of disease in both these countries now from the foreign born population. Both countries have close links with a number of the WHO recognized high burden countries. To achieve the target of TB eradication a variety of new strategies including new diagnostics drugs and vaccines will be required.

An important component of TB management is diagnosis of the patient in a quick and efficient manner. This includes recognition of symptomatology by both the patient, primary and secondary medical care. Then rapid and effective diagnostic tools need to be available to confirm the diagnosis and provide susceptibility results in a timely manner.

This talk will go through these issues and discuss some of the new diagnostic techniques, including Xpert MTB/RIF test, that have become available in recent times and describe their use in both adult and paediatric population.

THE QUICK AND THE DEAD: CLINICAL IMPACT OF RAPID MICROBIOLOGICAL DIAGNOSTICS

Stephen McBride

Middlemore Hospital, Otahuhu, New Zealand

The management of infection is a critical part of medical practice, and in critically unwell patients delay in antimicrobial therapy active against the infecting organism is associated with poor patient outcome. Recent years have seen massive advancements in rapid microbiological diagnostics and their proliferation from the research laboratory to the clinical laboratory and hospital practice.

This case-based presentation will explore how real-world application of rapid microbiological tests can impact on patient management and outcomes, and how these technologies can be applied in different hospital settings.

MENINGOCOCCAL DISEASE: AN UPDATE

Mark Thomas

Auckland Hospital, New Zealand

Disease due to Neisseria meningitidis is among the most terrifying of all infectious diseases. The presentation may be dominated by the non-specific features arising from diffuse intravascular infection or by the typical features of acute meningeal infection. Often features of septicaemia and of meningitis are present.

The outcome is worst in those with uncontrolled intravascular infection – fulminant meningococcaemia, and is strongly correlated with the concentration of bacteria in the blood, which may be as high as 10E11/L.

Measurement of serum pro-calcitonin has been recommended as a diagnostic aid, but is not widely used. The diagnosis is confirmed by visualizing Gram negative cocci in CSF or blood, by culturing the organism from blood or CSF, or by detecting meningococcal DNA in blood, CSF or tissue.

Treatment is with benzyl penicillin 12 MU / day for 3 days. Corticosteroids may offer some benefit.

Immunisation provides a high level of protection against disease due to group A and C strains, but provides only modest protection, for a short duration, against disease due to group B strains.

TBD: Obesity and Epigenetics, Diabetes and Endocrine AMD/PCHD

  1. Top of page
  2. P&CHD – Neonates
  3. P&CHD – Respiratory
  4. P&CHD – Neurology
  5. P&CHD/AMD – Infectious Diseases
  6. TBD: Obesity and Epigenetics, Diabetes and Endocrine AMD/PCHD

THE PRACTICAL MANAGEMENT OF CHILDHOOD OBESITY

Matthew Sabin

Approximately 1 in 4 children and adolescents are either overweight or obese. With this comes a heavy workload for paediatricians – not only in terms of screening for obesity and its related complications, but also instituting appropriate and effective management approaches. This talk will outline the main causes and consequences of childhood obesity, with practical advice and tips for the busy general paediatrician.

Allan Sheppard

ABSTRACT NOT AVAILABLE AT THIS TIME

AN UPDATE ON BARIATRIC SURGERY FOR PHYSICIANS

Grant Beban

Bariatric Surgery is increasingly used for the treatment of severe obesity and its associated illnesses.

Although studies show good long term results in most series with acceptable complication rates, there can be uncertainty around when to consider bariatric surgery and which operation may be best.

Who may (or may not be) appropriate for surgery, usual outcomes of surgery regarding weight and other conditions, and the complications physicians need to be aware of will also be presented.

The pros and cons of the main procedures that are currently available will be discussed, along with how these may be taken into account when considering surgery for a particular patient. I will also touch on some of the evolving indications for bariatric surgery, and the interaction with usual models of care.