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关键词： Allograft   Bone fusion   Children   Craniocervical instability   Surgical technique  

摘要： Background Occipitocervical and atlantoaxial instability in the pediatric population is a rare and challenging condition to treat. Variable surgical techniques have been employed to achieve fusion. The study aimed to assess bony fusion with rigid craniocervical fixation using an allograft bone block to serve as scaffold for bony fusion. Methods This is a single center case series from a tertiary referral neurosurgical center. The series includes 12 consecutive pediatric patients with rigid craniocervical fusion between 2006 and 2014. The primary outcome was bony fusion as assessed by computed tomography and flexion-extension radiographs. The authors did not receive external funding for this study. Results Twelve patients (age 1-15 years) were operated with a median imaging follow-up time of 22 months (range 6-69 m). A modified Gallie fusion technique with a tightly wired allograft bone block was used in 10 of 13 procedures. One patient underwent re-fixation due to screw breakage. Eleven out of 13 procedures resulted in a stable construct with bony fusion. All 10 patients operated with the modified Gallie fusion technique with sublaminar wiring of allograft bone block had bony fusion. No post-operative complications of the posterior fixation procedure were noted. Conclusions The modified Gallie fusion technique with allograft bone block without post-operative immobilization achieved excellent fusion. We conclude there is no need to use autograft or BMPs in craniocervical fusion in the pediatric population, which avoids related donor-site morbidity.

摘要： Corrigendum to: The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): first EUROMACS Paediatric (Paedi-EUROMACS) report [Eur J Cardiothorac Surg 2018;54:800-8]. [Extracted from the article]

关键词： Critical care   Child   Nutrition   Protocol   Clinical decision support system  

摘要： Background: For critically ill children hospitalised in paediatric intensive care units, adequate nutrition reduces their risk of morbidity and mortality. Barriers may impede optimal nutritional support in this population. Moreover, physicians are usually responsible for prescribing nutrition, although they are not experts. Therefore, tools may be used to assist in nutritional decision-making, such as nutrition protocols. Objectives: The objective of this two-stage qualitative study was to explore the perceptions of physicians about their management of enteral nutrition in a paediatric intensive care unit and the implementation of a nutrition protocol and computerised system. Methods: This study involved semistructured interviews with physicians at the Paediatric Intensive Care Unit of Lausanne University Hospital, Switzerland. Research dietitians conducted interviews before (stage one) and after (stage two) the implementation of a nutrition protocol and computerised system. During stage one, six junior physicians and five fellows were interviewed. At stage two, 12 junior physicians, 12 fellows, and five senior physicians were interviewed. Interviews were recorded, with data transcribed verbatim before a thematic analysis using a framework method. Results: Three themes emerged from thematic analysis: "nutritional knowledge", "nutritional practices", and "resources to manage nutrition". During stage one, physicians, especially junior physicians, reported a lack of nutritional knowledge for critically ill children and stated that nutritional issues primarily depended on senior physicians, who themselves had various practices. All physicians were in favour of a nutrition protocol and computerised system. At stage two, interviewees stated that they used both tools regularly. They reported improved nutritional knowledge, more systematic and consistent nutritional practices, and increased attention to nutrition. Conclusions: The implementation of a nutrition protocol and

关键词： antibiotics   granulocyte-colony stimulating factor   infection   neutropenia   newborn  

摘要： Aim To describe the presenting features and investigation findings in infants diagnosed with neonatal alloimmune neutropaenia (NAIN) within an Australian paediatric health network. The secondary aim was to describe the management and resolution of neutropaenia in infants with NAIN. Methods A retrospective cohort study was conducted at Monash Children's Hospital, Melbourne, Australia. Infants referred to the Victorian Transplantation and Immunogenetics Service for evaluation of NAIN were identified and medical records were reviewed. Descriptive statistical analysis of infants' clinical outcomes, investigation findings and management was performed. Results Nine infants were diagnosed with NAIN between December 2004 and June 2017. Overall incidence of NAIN was around 1 per 10 000 births. Median gestational age was 38 (range 35-40) weeks and birthweight was 2920 (2300-4445) g. Median age at NAIN work-up was 7 (2-33) days. Prior to investigation for NAIN, median absolute neutrophil count was 0.2 (0.01-0.6) x 10(9) cells/L. The post-natal ward was the source of presentation in most infants (78%). All except one infant were admitted to a neonatal unit and commenced on intravenous antibiotics (89%). Six infants were asymptomatic but received antibiotics for risk of infection (75%). Granulocyte-colony stimulating factor was administered to 44% of infants due to neutropaenia with presumed or confirmed infection. NAIN resolved at median age of 32 (6-200) days. Conclusions Infants with NAIN frequently presented with severe, unexpected neutropaenia without major infection. Intravenous antibiotic therapy and granulocyte-colony stimulating factor use was common in this cohort.

关键词： congenital cataract   paediatric cataract   phacoemulsification   primary intraocular lens   secondary glaucoma   visual axis opacification  

摘要： Purpose To determine predictors of secondary glaucoma and poor visual outcome in children undergoing cataract surgery with bag-in-the-lens (BIL)-IOL implantation. Methods Medical records were retrospectively analysed for children with primary implantation with BIL-IOL during 2009-2013. Results The study included 109 eyes. Median age at surgery was 2.5 years (range 2 weeks-14.1 years), 26.6% being <= 12 weeks of age (= early group). Median follow-up time was 2.8 years (7 months-5.8 years). 15 eyes (13.8%) developed glaucoma, 14 (48.3%) in the early group and 1 (1.3%) in the late group (p < 0.001). Within the early group, mean time for surgery differed significantly. Patients developing glaucoma had cataract surgery at 3.5 +/- 1.1 weeks (mean +/- SD) and the non-glaucoma patients at 5.7 +/- 3.3 weeks (p = 0.024). In the entire cohort, 21 eyes (19.3%) had conditions associated with glaucoma;57.1% of these developed glaucoma compared to 3.4% without these conditions (p < 0.001). Corrected distance visual acuity (CDVA) (decimal) of >= 0.5 was seen in 50 eyes (48.5%), median 0.63 in the late group and 0.15 in the early group. Glaucoma eyes in the early group (surgery at 3.5 weeks) achieved 0.56 median (range, 0.4-1.0) logMAR, (0.28 decimal) CDVA, whereas non-glaucoma eyes (surgery at 5.7 weeks) achieved 0.89 median (range 0.7-1.6) logMAR (0.13 decimal) CDVA;p = 0.016. Glaucoma development in infants between 5 weeks and 2 years of age was 6.7% (n = 2/30). Conclusions Comorbidity strongly increases the risk of secondary glaucoma. Surgery during the first month is correlated with better CDVA outcome and glaucoma. After 5 weeks of age, glaucoma rate is low with the BIL-IOL.

摘要： Currently, coaching is increasingly applied to foster the involvement of families with an infant or young child with special needs in early intervention and paediatric rehabilitation. Coaching practices are included in many forms of intervention and are regarded as essential to reach beneficial outcomes for the child and family. There are, however, many ambiguities that blur the concept of coaching and hamper its understanding and integration as an evidence-based approach in early intervention and paediatric rehabilitation: lack of differentiation between coaching and training of families, for example. Challenges to incorporate coaching into professional practice relate to adult learning processes and knowledge acquisition, and transformation of attitudes, beliefs, and treatment habits. In this paper, we review the barriers encountered and the possibilities available to promote successful implementation of coaching in early childhood interventions. What this paper adds Literature defines coaching ambiguously, which hampers its implementation in early intervention. The term 'coaching' should be reserved for relationship-directed, family-centred intervention.

关键词： Anaesthesia   airway < anaesthesia   3D printing   paediatric anaesthesia   education < intensive care  

摘要： There is a deficit of commercially available paediatric airway models for anaesthesia airway management training, particularly for infant front-of-neck access and customised airway planning. Acknowledging this, we created a three-dimensional printed prototype for an affordable, high-fidelity training device, incorporating realistic tactile feedback, reproducibility and potential for modification for specific patient pathologies. Our model, created on a Stratasys Polyjet J750TM (Rehovot, Israel) printer, is a novel and useful educational tool in paediatric airway management, and we are pleased to share access to this resource with readers. Our work adds credence to three-dimensional printing as an accessible, reproducible and pluripotent technology in clinical anaesthesia.

关键词： hermeneutics   intensive care units-paediatric   nurse administrators   organisational innovation   social identification  

摘要： Aim To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change. Background While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity. Method The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n = 15) in a large Canadian paediatric hospital. Results Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions. Conclusion Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes. Implications for Nursing Management The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated;2) the physical environment needs to be considered when determining staffing requirements;and 3) identity transitions need to be managed.

摘要： How we deal with the COVID-19 epidemic in an Italian paediatric onco-haematology clinic located in a region with a high density of cases The first cases of the novel COVID-19 coronavirus in Italian patients, following the epidemic in China which began in December 2019, were reported on 20 February 2020. Overall, in a six-week-period since establishing these measures, we screened at triage for COVID-19 over 855 patients and tested 31 patients for COVID-19 using naso-pharyngeal swabs. [Extracted from the article]

关键词： Knowledge   Radiation dose   Paediatric   Protocols  

摘要： Introduction: Digital radiography (DR) poses the risk of unnoticed increases in patient dose, potentially resulting in the overexposure of paediatric patients. In some jurisdictions, there is a shortfall in the knowledge and application of safe paediatric radiation dose protocols. In such instances, radiographers can lack an understanding of the relationship between exposure index (EI) and the visual appearances of image noise, thereby resulting in under- or overexposure to the paediatric patient. Methods: A quantitative, descriptive research study was conducted at six purposively selected diagnostic radiology departments in Gauteng, South Africa. The study was based on a 29-item questionnaire seeking to quantify the radiographers' knowledge of paediatric radiation dose protocols and whether their knowledge translated into safe radiation dose practice. Results: A 94% (61/65) response rate was achieved. Results show a low number of respondents (35, 57%) expressed a positive opinion of their knowledge of paediatric radiation dose protocols and EI;however, 41 (67%) participants were unaware of the function of EI. Conclusion: The study revealed that, in Gauteng, there is an increased demand for further training in paediatric radiation dose protocols and a need for radiographers to improve awareness of exposure factors. Implications for practice: Improving radiographers' lack of knowledge of paediatric radiation dose protocols in Gauteng is important. It is essential that radiographers receive continuous training and education highlighting the importance of justification and optimisation of radiological examinations. (c) 2019 The College of Radiographers. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://***/licenses/by-nc-nd/4.0/).