Globally, more than 10 million children die annually, and the majority of these deaths occur in sub-Saharan Africa (41%) and southern Asia (34%), where under-5 mortality is attributed mainly to diarrhoea, pneumonia, measles, malaria, HIV/AIDS and malnutrition. [1,2] Neonatal deaths occur due to asphyxia, preterm delivery, sepsis and tetanus. [2] A country's epidemiological profile and health system largely dictate the implementation and development of public health interventions that will improve childhood survival. [1] Little is known about the need for paediatric high care and critical care in low-and middle-income countries, but published results indicate an inadequate quality of care with high mortality rates. [3] Lack of infrastructure, human resources and expert support leads to children being managed in general wards with low nurse-to-patient ratios, resulting in an increased risk of nosocomial infections and death. [3-6] Paediatric intensive care is defined as a 'physical space that is designated to manage critically ill children who require comprehensive and intensive healthcare' , and should be available to all children irrespective of where they live. [7] Research in developed countries suggests that paediatric intensive care units (PICUs) should be centralised with good retrieval services to ensure safe access. There is no clear guidance regarding the infrastructure of a PICU in a low-or middle-income country where transport services often are weak or non-existent. [8] Transfer of critically ill children poses a challenge in South Africa (SA), and a study from Cape Town revealed a high incidence of transfer-related adverse events in children transferred from non-academic metropolitan hospitals to tertiary care centres. [9] Critically ill children are, therefore, often managed by non-specialist staff in non-tertiary general intensive care units admitting both adults and children, but few data are currently available regarding paediatric outcomes in these general units. [9] This study was done to determine the outcome of neonates and children admitted to a general high-care unit under the care of paediatricians at a large regional hospital in the Western Cape Province, SA. Methods The study was conducted at the large regional hospital in Worcester, SA. Worcester Hospital is the regional hospital for the Winelands/ Overberg region of the Western Cape, with ~1 million inhabitants, of whom 1.6% were <1 year of age. The infant mortality and childhood mortality rates at the time of the study were 25.3 and 31.2/1 000 live births, respectively. [10] The hospital has a five-bed general high-care unit. One of these beds is dedicated to paediatric care. The care of neonates and children admitted to the high-care unit takes place under the supervision of a paediatrician, supported by either a paediatric registrar, medical officer or intern depending on the call list. The nursing staff includes six registered nurses trained in adult intensive care and one registered nurse trained in paediatric intensive care. Child...
Background: Viral meningitis is the most common form of aseptic meningitis and requires minimal investigation and treatment. Polymerase chain reaction (PCR) has become the 'gold standard' for identifying viruses in cerebrospinal fluid and can provide rapid results. The objective of the study was to describe the aetiology and epidemiology of viral meningitis at Tygerberg Children's Hospital, as well as the impact of a positive cerebral spinal fluid (CSF) viral panel on the duration of empiric antibiotic treatment. Methods: This was a retrospective folder review of all children aged between 29 days and 13 years who had a CSF specimen on which a viral analysis was performed from January 1, 2010 to December 31, 2014. Results: A total of 288 specimens were identified from the laboratory database. Seventy-nine specimens were presented for data analysis. Thirty-seven specimens had a positive viral analysis. The median age was 11.3 months (IQR 3.7-49.16 months). The microscopy and chemistry results were similar for the two groups except for the CSF lymphocyte count, which was significantly higher in the group with a positive CSF viral analysis compared to those with a negative CSF viral analysis (median 52 vs. 12 × 106/l, p = 0.005). The most common identified virus was Epstein-Barr virus (EBV) (23%), followed by enterovirus (17%). Children with a positive viral analysis tended to receive antibiotics for longer than those who had negative results (p = 0.223). Conclusion:The addition of CSF viral analysis could be helpful in the management of children with meningitis, but at present appears to have little impact on the length of antibiotic use.
Background: Viral meningitis is the most common form of aseptic meningitis and requires minimal investigation and treatment. Polymerase chain reaction (PCR) has become the ‘gold standard’ for identifying viruses in cerebrospinal fluid and can provide rapid results. The objective of the study was to describe the aetiology and epidemiology of viral meningitis at Tygerberg Children’s Hospital, as well as the impact of a positive cerebral spinal fluid (CSF) viral panel on the duration of empiric antibiotic treatment.Methods: This was a retrospective folder review of all children aged between 29 days and 13 years who had a CSF specimen on which a viral analysis was performed from January 1, 2010 to December 31, 2014.Results: A total of 288 specimens were identified from the laboratory database. Seventy-nine specimens were presented for data analysis. Thirty-seven specimens had a positive viral analysis. The median age was 11.3 months (IQR 3.7–49.16 months). The microscopy and chemistry results were similar for the two groups except for the CSF lymphocyte count, which was significantly higher in the group with a positive CSF viral analysis compared to those with a negative CSF viral analysis (median 52 vs. 12 × 106/l, p = 0.005). The most common identified virus was Epstein–Barr virus (EBV) (23%), followed by enterovirus (17%). Children with a positive viral analysis tended to receive antibiotics for longer than those who had negative results (p = 0.223).Conclusion: The addition of CSF viral analysis could be helpful in the management of children with meningitis, but at present appears to have little impact on the length of antibiotic use.
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