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Background and Aims

Researchers have emphasized that nursing consultation in the preoperative period is beneficial for children and their parents. This study aimed to compare educational intervention with a Brazilian educational comic book and oral information versus oral information alone for children and their parents before paediatric surgery.

Methods

A quasi-experimental study was conducted at a public university in Brazil. The educational material, including digital versions, had been produced in a previous study. The content of the comic book was previously validated, and its face validity for use in children's perioperative care was previously confirmed. The inclusion criteria were as follows: children aged 6-14 years, American Society of Anesthesiologists physical status classification of I or II, and undergoing their first elective surgical procedure. A questionnaire was used to collect data on the sociodemographic characteristics of the children and their parents. To assess the children’s knowledge about surgery, a questionnaire for children aged 6 to 10 years and another for children aged 11 to 14 years were used.

Results

Thirty-nine children and their parents participated in this study. There were 20 children in the intervention group and 19 children in the control group. The two groups were homogeneous in terms of sociodemographic characteristics. In both groups, for both the children and their parents, there was a significant difference between pre-and post-orientation scores. However, there was no difference in knowledge scores between the two educational strategies.

Conclusions

Educational interventions performed by nurses are beneficial for increasing knowledge among patients and family members regardless of the method used.

Background and Aims

Following cardiovascular surgery, chest and mediastinal drains are often used in children for preventing air, blood or other fluids from accumulating in pleural and mediastinal spaces, as well as the continuation of hemodynamic stability and follow-up. During this follow-up, the most significant complication that might cause an additional surgery is the blockage of drainage tubes. This study was conducted as a randomized controlled experimental study to determine the effect of using milking and sucking methods in maintaining the drain patency following a heart surgery in children with chest and mediastinal drains on the amount of bleeding, vital signs, and oxygen saturation.

Methods

While the control group of the study comprised 1-12 month-old children (n=30) to whom no procedure regarding the maintenance of drain patency was applied, the experimental groups consisted of 1-12 month-old children to whom the sucking method (n=30) and the milking method (n=30) were applied. For each group, the data concerning were recorded by following up the patient for six hours following the surgery as from the moment she/he was admitted to the intensive care unit.

Results

As a result of the study, it was found that an increase might be caused in the heart rate unless a method was chosen in maintaining the drain patency; using the sucking method provided a positive stability in terms of oxygen saturation and respiratory rate.

Conclusions

It was determined that the use of the sucking method in the maintenance of drain patency created a positive effect on controlling the amount of bleeding.

Background and Aims

The hospitalization of a preterm infant in the neonatal intensive care unit (NICU) leads to negative parental feelings which are believed to affect family functioning. These habits are mitigated by family resilience, which is protective against psychological symptoms during family experiences of adversity such as preterm birth. In order to adequately assess family resilience, a reliable and valid instrument is imperative, but few with adequate psychometric properties are available. Yet, the Family Resilience Assessment Scale (FRAS) has undergone several successful cross-cultural validations but remains unavailable in French and unspecific to the neonatal context. The aim of this research is to translate into French, adapt and validate the FRAS with parents of French-speaking preterm infants.

Methods

A five-phase methodological design is planned: (I) translation into French (II) content validation of the translated items by a group of 12 (nurses, experts and parents of premature infants), (III) computer administration of the FRAS to 330 parents of preterm infants recruited from 4 level III NICUs (IV) adaptation of the FRAS into a short version and (V) evaluation of its psychometric properties (internal consistency, construct validity, factor structure, inter-rater reliability).

Results

This study will provide researchers and clinicians with a reliable and valid instrument of family resilience to allow for the acquisition of compelling findings in both research and clinical settings concerned with family resilience in the NICU.

Conclusions

This study contributes to the conceptual development of family resilience and will guide the implementation of family-centered practices in NICUs.

Background and Aims

Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare and lacks clinical data, especially with respect to antenatal prediction of neonatal outcome. The purpose of this study was to identify prenatal prognostic indicators in RCDH.

Methods

We retrospectively reviewed the medical records of newborn infants with RCDH and born at gestational age ≥ 35 weeks. Clinical and prenatal characteristics including fetal lung volume measured by observed versus expected lung area to head circumference ratio (O/E LHR) were compared and analyzed between the survivors and the non-survivors.

Results

Among a total of 34 patients of isolated RCDH, 24 (70.6%) patients survived to discharge. Compared with the non-survivors, survivors had higher incidence of mediastinal shifting in utero. The O/E LHR was significantly greater in the survivors (67.0 ± 19.9) than in the non-survivors (42.4 ± 25.0) (P < 0.05). The O/E LHR was also good predictor for ECMO or death (AUC 0.870, P < 0.01), and mortality (AUC 0.789, P < 0.05). The best cut-off for O/E LHR was 47 in the prediction of mortality (92% sensitivity and 78% specificity), and ECMO or death (80% sensitivity and 83% specificity) in isolated RCDH.

Conclusions

The survival rate of patients with isolated RCDH was comparable to that of the left-sided CDH. The O/E LHR of the contralateral lung was a reliable predictor of short-term postnatal outcome in RCDH.

Background and Aims

Background and aims: Inappropriate interprofessional collaboration (IPC) may contribute to sub-optimal pediatric pain management, but evidence is scarce in this context. To evaluate healthcare professionals’ perceptions of IPC in their pain practice and to assess relations between sociodemographic data and perceived IPC.

Methods

Methods: This observational study included a convenience sample of healthcare professionals from medical, nursing, and allied health, working for at least three months in a university hospital in Switzerland, and caring for children aged between 1 and 18 years. Participants responded to the Assessment of Interprofessional Team Collaboration Scale II, which includes three dimensions: partnership, cooperation, and coordination rated on a Likert scale (from 1 (the lowest) to 5 (the highest)). Descriptive and correlational analyses were performed. Four open-ended questions were added at the end of the questionnaire to allow participants to share additional reflections on IPC and pediatric pain management.

Results

Results: A total of 140 participants from five professions were included (response rate 45%). The mean AITCS-II score was 3.77 (SD 0.61). The mean score for partnership was 3.83 (SD 0.69), for cooperation 4.05 (SD 0.50), for coordination 3.43 (SD 0.82). Physicians perceived a higher degree of IPC when compared to nurses (4.08 (SD 0.49) and 3.59(SD 0.61), p = 0.006, respectively). Thirteen themes emerged from content analysis, revealing a need in IPC training and new measures for assessing child pain.

Conclusions

Conclusions: Our results show that IPC overall is suboptimal, especially in the partnership and the coordination domains. IPC should be improved to avoid unnecessary children’s suffering.

Background and Aims

Perinatal-Life-Support (PLS) research is progressing to provide extreme premature infants a safe extracorporeal environment for further growth. A crucial step before being accepted into healthcare is the careful validation of life-support technology. However, clinical trials with living subjects yields great ethical concerns and limits testing and training of early-stage concepts. A promising alternative can be found in manikins, which can resemble infants on an anatomical and even physiological level.

Methods

An analysis was performed defining the design framework for the manikin to function as a validation model for PLS-technologies. A scientific literature review was conducted to identify parameters involved in the physiologic events that need to be prevented when transferring a perinate into a PLS-system, avoiding neonatal transition and maintaining fetal status.

Results

In our proposed framework, output of embedded sensors is compared to parameter threshold values as set in a linked computational model. The manikin’s embedded actuators could display symptoms, serving as a feedback loop during testing and training. The parameters include temperature, lung aeration, liquid clearance of lungs, umbilical cord compression, heart rate, blood pressure and flow. Symptoms include chest expansion, gasp reflex, cyanosis, vasospasm, and decreased fetal movement. Lastly, based on MRI scans, a 3D manikin prototype was developed that contains space for hardware integration.

Conclusions

The development of a simulation to validate a life-support system, not yet tested on humans, is unprecedented. With the proposed framework and requirements, we expect improved feedback during dimensional testing and training, allowing for design improvements and eventually promote success of future clinical trials.

Background and Aims

IMPLEMENTATION OF NEWBORN EARLY WARNING SYSTEM IN GOVERNMENT HOSPITAL, UAE

A Paulose; E Jose; A Bystricka; J M Khan

NICU, Al Rahba Hospital, UAE

INTRODUCTION

Significant morbidity and mortality might occur in neonates due to absence of early warning system. The seriousness of this issue is due to rapidity of neonates to become unwell if it is not recognized early. Although usefulness of early warning signs in adult and pediatric is well documented, there is paucity of information related to usage and effectiveness of neonate early warning signs.

AIM: To discuss implementation of  newborn early warning system (NEWS) in government hospital, UAE.

Methods

DESIGN: A quality improvement project was implemented. We used chart reviews and focus group feedbacks that were conducted in level 3 NICU of one hospital in UAE.

METHODS: A 3 month (January to March 2018) retrospective and prospective (July to September 2018) chart reviews were conducted of babies admitted to NICU by using adapted tool (NEWS chart NHS Plymouth Hospitals). Statistical analysis was used mainly frequency and percentages and themes for qualitative data.

Results

RESULTS: Of 171 babies from retrospective study,104 (60.8%) had risk and 67 (39.2%) had no risk factors.50 babies from risk and 14 from no risk factors were admitted to NICU.Of 191 babies from prospective study,138 (72%) had risk and 53 (28%) had no risk factors.Overall 73 babies from risk and 18 from no risk factors were admitted to NICU.

Conclusions

CONCLUSIONS:This new tool helped to identify babies at risk and with abnormal physiological parameters at early stage.