pilot was carried out from 8 am-8 pm Monday to Friday. Data collected included time of arrival and assessment, admission rates, parental and staff satisfaction. Results During Jan 2013 and April 2013 between 8 am-8 pm there was a total of 785 admissions. A retrospective analysis was carried out on 80 randomly selected charts. Ages ranged from 3 weeks to 13 years 9 months, with a median age of 3 years 5 months. 97% of patients were seen within 4 h of nursing triage with only 59% being reviewed by a senior doctor within the following 4 h of their initial medical review.There were 100 APAU admissions during May 2013. Only 87 charts were available and audited. Ages ranged from 2 days to 14 years with a median age of 1 year 7 months. Common diagnoses included gastroenteritis and respiratory tract infections. 100% of patients were medically assessed within 4 h of nursing triage with 85% of patients being reviewed by a senior doctor within the following 4 h (p value 0.01).Admission rates fell from 95% to 44% during the hours of 8 am-8 pm (p value < 0.0001). Staff impression of our facilities for managing direct admissions as good or excellent improved from 25% to 95%. Patient and parent feedback was excellent. Conclusion We have shown that developing a model of acute paediatric assessment in a DGH setting can both reduce admissions and improve quality outcomes. Both physical infrastructure and funding remain issues for sustainability however we believe that this project demonstrates the value in investing in acute paediatric care.Primary Care: Infections Background and aims The smoking parent is considered a risk factor of severity for acute bronchiolitis (AB). We aimend to evaluate the relationship between parental history of smoking and length of stay of infants hospitalised for AB. Methods Prospective descriptive study including all infants admitted for moderately bronchiolitis, between 2011 and 2013. They were grouped in smoking parent or not. Severe bronchiolitis and patients with serious risk factors were excluded. The primary outcome was length of stay (LOS). The following variables were recorded: age, sex, atopic dermatitis, parental atopy, number of siblings, breastfeeding, RSV, treatment received, need for PICU, mortality and clinical score at admission. Results Among the 137 enrolled infants, 56.2% had no smoking parent. There were no statistically significant differences (p > 0.05) between the two groups in the following variables: median age (40 vs 59 days), male gender (48% vs 53%), atopic dermatitis (6.7% vs 15.6%), breastfeeding (59.7% vs 53.3%), number of siblings (0.66 vs. 0.63) day care attendance (16.9% vs. 6.7%), severity score (5.35 vs 5.28), percentage of positive RSV (67% vs 65%) and PICU admission (7.8% vs 5%). There were statistically significant differences in parental atopy (p =
Background and aims The advantages of breastfeeding are largely documented. Amongst other positive effects it reduces the risk of infectious disease in infants. We evaluated the effect of breastfeeding in the length of stay for infants with moderately ill bronchiolitis. Patients and methods Prospective descriptive study including all moderately ill bronchiolitis infants admitted to our hospital between 2011-2014. They were grouped in exclusively breastfed or not. Severe bronchiolitis and patients with serious risk factors were excluded. The primary outcome was length of stay (LOS). The following variables were recorded: age, sex, atopic dermatitis, parental smoking, atopy in parents, number of siblings, RSV, treatment received and clinical scale of bronchiolitis at admission. Results Among the 185 enrolled infants, 54.5% were exclusively breastfed. There were no statistically significant differences (p > 0.05) in: male gender (47% vs 44%), atopic dermatitis (31% vs 31%), smoking parents (37% vs 44%), parental atopy (31% vs 31%), number of siblings (0.66 vs. 0.68) day care attendance (16% vs. 10%) and percentage of positive RSV (61% vs 60%). The median LOS in the breastfeeding group was 3.14 days compared with 2.82 days in the other group (p = 0.004). There were statistically significant differences in median age (p = 0.000) and the severity at admission (p = 0.021). Conclusion In our series, breastfeeding does not protect from bronchiolitis. The breastfed group were admitted at a younger age which could explain their longer LOS. Interestingly, breastfed infants had a lower score of severity at admission suggesting a relative protective role of against severe bronchiolitis. Background and aims Cardiac dysfunction during bronchiolitis has been reported but few studies have assessed right ventricular function (RVF). The aim of this study was to assess RVF in infants with severe bronchiolitis with different respiratory support. Methods Prospective study of under 3-month-old infants admitted to the PICU for severe bronchiolitis. Patients were classified in 3 groups according to the respiratory support: CPAP, bilevel positive airway pressure (BLPAP) and mechanical ventilation (MV). If the respiratory support was changed, echocardiography was repeated. Morphology and systolic and diastolic function were evaluated by echocardiography including Tissue Doppler imaging (TDI). O-017 RIGHT VENTRICULAR FUNCTION IN INFANTS WITH SEVERE BRONCHIOLITIS AND DIFFERENT RESPIRATORY SUPPORTResults 30 echocardiographies were performed: 9 in infants with CPAP (4-8 cmH 2 O), 10 in BLPAP (13-16 cmH 2 O/6-8 cmH 2 O) and 10 in MV (PEEP 5-9 cmH 2 O and MAP 9-17 cmH 2 O). There was no difference in age or weight between the groups. The most relevant results are shown in Table 1. Conclusions As respiratory support increases, decreased systolic and diastolic RVF is observed by TDI in infants with severe bronchiolitis. -2014-307384.87 Background and aims No bronchodilator nebulised in saline has significantly proven to be more effective than...
Background and aims The advantages of breastfeeding are largely documented. Amongst other positive effects it reduces the risk of infectious disease in infants. We evaluated the effect of breastfeeding in the length of stay for infants with moderately ill bronchiolitis. Patients and methods Prospective descriptive study including all moderately ill bronchiolitis infants admitted to our hospital between 2011-2014. They were grouped in exclusively breastfed or not. Severe bronchiolitis and patients with serious risk factors were excluded. The primary outcome was length of stay (LOS). The following variables were recorded: age, sex, atopic dermatitis, parental smoking, atopy in parents, number of siblings, RSV, treatment received and clinical scale of bronchiolitis at admission. Results Among the 185 enrolled infants, 54.5% were exclusively breastfed. There were no statistically significant differences (p > 0.05) in: male gender (47% vs 44%), atopic dermatitis (31% vs 31%), smoking parents (37% vs 44%), parental atopy (31% vs 31%), number of siblings (0.66 vs. 0.68) day care attendance (16% vs. 10%) and percentage of positive RSV (61% vs 60%). The median LOS in the breastfeeding group was 3.14 days compared with 2.82 days in the other group (p = 0.004). There were statistically significant differences in median age (p = 0.000) and the severity at admission (p = 0.021). Conclusion In our series, breastfeeding does not protect from bronchiolitis. The breastfed group were admitted at a younger age which could explain their longer LOS. Interestingly, breastfed infants had a lower score of severity at admission suggesting a relative protective role of against severe bronchiolitis. Background and aims Cardiac dysfunction during bronchiolitis has been reported but few studies have assessed right ventricular function (RVF). The aim of this study was to assess RVF in infants with severe bronchiolitis with different respiratory support. Methods Prospective study of under 3-month-old infants admitted to the PICU for severe bronchiolitis. Patients were classified in 3 groups according to the respiratory support: CPAP, bilevel positive airway pressure (BLPAP) and mechanical ventilation (MV). If the respiratory support was changed, echocardiography was repeated. Morphology and systolic and diastolic function were evaluated by echocardiography including Tissue Doppler imaging (TDI). O-017 RIGHT VENTRICULAR FUNCTION IN INFANTS WITH SEVERE BRONCHIOLITIS AND DIFFERENT RESPIRATORY SUPPORTResults 30 echocardiographies were performed: 9 in infants with CPAP (4-8 cmH 2 O), 10 in BLPAP (13-16 cmH 2 O/6-8 cmH 2 O) and 10 in MV (PEEP 5-9 cmH 2 O and MAP 9-17 cmH 2 O). There was no difference in age or weight between the groups. The most relevant results are shown in Table 1. Conclusions As respiratory support increases, decreased systolic and diastolic RVF is observed by TDI in infants with severe bronchiolitis. -2014-307384.87 Background and aims No bronchodilator nebulised in saline has significantly proven to be more effective than...
the most frequent infection among respiratory tract infections (30.1%). Conclusion Since, recent studies regarding to infectious diseases could be used for national planning and medical requirements' preparation, it seems that periodical assessment of these diseases is mandatory. -2014-307384.842 Brucellosis is a systemic infectious zoonotic disease andit is still an important public health problem in Arabian Peninsula. The clinical presentation of brucellosis is non-specific, and the infection varies in its course and severity. Objective To evaluate common presentations and complications of involvement of acute Brucella infection in children presented to the paediatric emergency unit of Aladanhospital Methods Design: Retrospective study Setting: Paediatric emergency unit and paediatric department of Aladdin hospital, Kuwait between April 2008 and April 2013. PO-0181Subjects: Sixty two children with acute brucellosis The diagnosis of brucellosis was made with compatible clinical findings, positive Brucella agglutination 1/160 titers, and/or the isolation of Brucella species. Complication was defined as the presence of symptoms or physical signs of infection at a particular anatomic site in a patient with active brucellosis. Data of the patients were reviewed in the medical records specially clinical presentation, complications, laboratory results, and treatment given. Results Out of 62 patients, 36(58.1%) were male and 26 (41.9%) were female. The mean age was 9.5 ± 3.2 years. Arthritis (42 patients,67.7%) was the most frequent, presentation followed by fever without source (24 patients, 38.7%), and gastrointestinal system (11 patients, 17.7%). The diagnosis depended on increase of brucella titer more than 1/160 in 57 patients (91.9%). Source of infection in patients was mostly ingestion of unpasteurized milk. Conclusion Brucellosisis still an important health problem in Kuwait and must be taken inconsideration in children presented with fever without a source or arthritis. Objectives To assess the efficacy of early estimation of serum high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL)-6 to differentiation between infants less than 3 months of age had sepsis and those free of infection and to assess their use as early predictor for result of blood culture (BC). PO-0182 DIAGNOSTIC IMPORTANCE OF SERUM CRP AND IL-6 FOR EARLY INFANTILE SEPSISPatients and methods The study included 90 infants less than 3 month old, admitted to paediatric department of Benha university hospital, all of them showed clinically features of sepsis. Our patients were subdivided into; clinically septic infants with positive BC, clinically septic infants with negative BC and suspected septic infants with negative BC. Two venous blood samples were obtained: The first at time of hospital admission for ELISA estimation of hs-CRP and IL-6 serum levels and the second sample was obtained either at time of development of clinical signs of sepsis or at 72 h in non-infected groups. Results Blood culture was positive in 42 infants, 2...
Backgrounds and aims Wood Downes's modified by Ferres score (WDF) was not designed for the bronchiolitis, but its use has been generalised to evaluate the severity. Our aim is to relate the length of stay and the bronchiolitis´s severity at admission, by WDF. Patient and methods We included the acute bronchiolitis hospitalised during two epidemics (2011)(2012)(2013). They were classified in mild (MiB; WDF <4), moderated (MB; WDF 4-7) or severe (SB; WDF > 7) according to the scale WDF realised at admission. The mild ones and to the patients without WDF at admission were excluded. The main variable was the length of stay. We registered: age, RSV, sex, previous and during treatment and UCIP's need. Analysis with SPSS 17.0. Results 208 hospitalised infants were included (mean age of 72,9 days (5-373). Positive RSV in 67,8%. 90,5% were MB and 9,5% SB. Both groups were homogeneous in demographics data and previous admission treatment (p > 0.05). The mean WDF at admission was 5,42 (4-10). During the hospitalisation, they received nebulised bronchodilator in 3% hypertonic saline solution (3%SSH) (65%) or 3%SSH (35%). 22% received corticoids and 8,2% antibiotics. Length of stay: 5,3 days (0-46). The MB had an mean length of stay of 4,8 days and the SB of 13,44 (p = 0.0001). Conclusions WDF's scale has demonstrated, in our sample, to be a good predictor of the length of stay in moderate and severe bronchiolitis. The SB had a statistically significant more length of stay than MB.
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