• The symptoms of UTI in infancy are very non-specific. • Old studies suggest that prolonged hyperbilirubinaemia is one such symptom; more modern studies give more conflicting results. What is New: • Our study could not confirm that children with prolonged jaundice have an increased risk of UTI. • Routine urine testing is thus not needed in otherwise healthy infants with prolonged jaundice.
Background The National Institute of Clinical Excellence (NICE) Guideline on Intrapartum care (2007) advises the duration and type of observations needed on neonates delivered in meconium-stained liquor. Aim This audit investigated current practice for postnatal meconium observations in maternity units in Kent, Surrey and Sussex (KSS). NICE guidance was used as the gold standard for comparison. Method All maternity units in KSS were contacted and their local protocol for meconium observations obtained. Results All 19 units responded. 10/19 (53%) units did not differentiate the duration of observations depending on the type of meconium, prolonging the duration of observations for light meconium-staining. Most units performed observations for a maximum of 12 h, however 3/19 (16%) units continued them for 24 h. All units recorded temperature, heart rate and respiratory rate as part of the observations. But only 7/19 (37%) units recorded capillary refill time. Overall, only 2/19 (11%) units were fully adherent to the NICE guideline. Discussion By not differentiating between types of meconium or by performing observations for 24 h, many maternity units across KSS are spending more time than recommended by the evidence on performing meconium observations, which misuses midwifery resources and potentially delays discharge. Although most signs of neonatal well-being are well recorded, by not recording the capillary refill time, many units are neglecting an important marker of neonatal distress, which could potentially compromise their care. A nationwide project is underway to identify whether these deviations from NICE guidance are present throughout the country’s maternity units.
AimThe RCPCH standards state a skeletal survey is the initial imaging method for evaluation of children where non-accidental injury is suspected with clear guidelines as to when surveys should be performed.Skeletal surveys require substantial resources to be performed and reported.In the current financial climate we wanted to evaluate the clinical use and practice of skeletal surveys in suspected non-accidental injury across the country.MethodsAn online anonymous survey (survey monkey) was cascaded to the college tutors via RCPCH. Results were collected and analysed.ResultsWe received 39 responses out of 250 college tutors.95% of tutors stated they routinely request skeletal surveys in the <1 year group, 50% in the <2 group and 10% in >2 years.43% of tutors report skeletal surveys are performed within 24 hours and 54% are performed between 24–48 hours from request.94% stated they had a weekday only reporting service.39% of tutors responded that average skeletal survey reporting occurred within 24 hours, 47% within 24–48 hours and 13% taking longer than 48 hours for a formal report to be issued.97% of tutors reported that skeletal survey reporting is done locally. Of this 97%, 17% of them also outsource reporting for a second opinion.83% of respondents stated that children would be admitted until a formal report was issued.ConclusionWe are requesting less skeletal surveys in the <2 age group than college guidelines would recommend.The vast majority of responses show that skeletal surveys are performed within a 48 hours window from requesting.The majority of reporting is performed locally however around 17% also outsource their reporting for second opinions which increases financial burden.The majority of respondents report that children would be admitted until a formal report was issued. Given that most college tutors state a weekday only reporting service children can be admitted overnight, creating a substantial demand on hospital beds.Further education should be provided to paediatric teams on when skeletal surveys are indicated and the financial and practical implications this has on the NHS.A limitation of this project is the low response rate, however reminder emails will be sent out to address this issue and results will be reanalysed.
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