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Magge HN, Schild SD, Mantilla-Rivas E, Landry EC, Afsar NM, Behzadpour HK, Manrique M, Rana MS, Oh AK, Reilly BK. Trends in Natural Decannulation in Patients with Robin Sequence: A Twenty-five Year Retrospective Review. Ann Otol Rhinol Laryngol 2024; 133:69-77. [PMID: 37497838 DOI: 10.1177/00034894231187290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Robin sequence (RS) consists of micrognathia and glossoptosis that result in upper airway obstruction (UAO). In RS patients who undergo tracheostomy, long-term goals include natural decannulation (ND) without further surgical airway intervention. The objective of this study was to identify long-term trends in the rate and length of time to ND. METHODS Retrospective chart review on 144 patients with RS treated from 1995 to 2020 at a pediatric tertiary care center. Patients were grouped by year of tracheostomy. Demographic data, UAO management, postoperative care, complications, and time to decannulation were recorded. RESULTS Thirty-six patients met the inclusion criteria. Tracheostomy was performed at a median age of 45.5 days. 19 (53%) patients experienced ND at a median time of 66.1 months. ND rate was higher in non-syndromic patients (93% non-syndromic vs 27% syndromic; P < .0001) and during the first study period (1995-2006: 78%, 2007-2020: 28%; P = .003). Cox proportional-hazard regression demonstrated that white race [aHR 0.15 (0.03-0.8); P = .023] and higher birthweight [aHR 0.9 (0.8-0.98); P = .018] were associated with a higher likelihood of ND while a syndromic diagnosis had a negative association with ND [aHR 12.5 (3.3-50.0); P < .001]. CONCLUSIONS Our study documented that ND in patients with RS who underwent tracheostomy was significantly associated with ethnicity, birthweight, and syndromic status. The negative impact on successful ND was most observed in patients with syndromic associations. Additionally, ND rates are lower in the 2007 to 2020 subgroup. We suspect this is because alternative management techniques such as tongue lip adhesion and mandibular distraction osteogenesis became primary surgical treatment in severe RS upper airway obstruction at our institution starting in 2007.
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Affiliation(s)
- Hari N Magge
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sam D Schild
- Division of Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Evie C Landry
- Division of Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Nina M Afsar
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Monica Manrique
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Md Sohel Rana
- Division of Surgery, Children's National Hospital, Washington, DC, USA
| | - Albert K Oh
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Brian K Reilly
- Division of Otolaryngology, Children's National Hospital, Washington, DC, USA
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Čverha M, Varga I, Trenčanská T, Šufliarsky B, Thurzo A. The Evolution of Robin Sequence Treatment Based on the Biomimetic Interdisciplinary Approach: A Historical Review. Biomimetics (Basel) 2023; 8:536. [PMID: 37999177 PMCID: PMC10669884 DOI: 10.3390/biomimetics8070536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
The Robin sequence is a congenital anomaly characterized by a triad of features: micrognathia, glossoptosis, and airway obstruction. This comprehensive historical review maps the evolution of approaches and appliances for its treatment from the past to the current modern possibilities of an interdisciplinary combination of modern engineering, medicine, materials, and computer science combined approach with emphasis on designing appliances inspired by nature and individual human anatomy. Current biomimetic designs are clinically applied, resulting in appliances that are more efficient, comfortable, sustainable, and safer than legacy traditional designs. This review maps the treatment modalities that have been used for patients with a Robin sequence over the years. Early management of the Robin sequence focused primarily on airway maintenance and feeding support, while current management strategies involve both nonsurgical and surgical interventions and biomimetic biocompatible personalized appliances. The goal of this paper was to provide a review of the evolution of management strategies for patients with the Robin sequence that led to the current interdisciplinary biomimetic approaches impacting the future of Robin Sequence treatment with biomimetics at the forefront.
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Affiliation(s)
- Martin Čverha
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty Comenius University in Bratislava and National Institute of Children’s Diseases, 83101 Bratislava, Slovakia;
| | - Ivan Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, 81372 Bratislava, Slovakia;
| | - Tereza Trenčanská
- Clinic of Pediatric Otorhinolaryngology of the Medical Faculty Comenius University in Bratislava and National Institute of Children’s Diseases, 83101 Bratislava, Slovakia;
| | - Barbora Šufliarsky
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Comenius University in Bratislava and University Hospital, 81372 Bratislava, Slovakia;
| | - Andrej Thurzo
- Department of Orthodontics, Regenerative and Forensic Dentistry, Faculty of Medicine, Comenius University in Bratislava, 81102 Bratislava, Slovakia
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van der Plas PPJM, van Heesch GGM, Koudstaal MJ, Pullens B, Mathijssen IMJ, Bernard SE, Wolvius EB, Joosten KFM. Non-Surgical Respiratory Management in Relation to Feeding and Growth in Patients with Robin Sequence; a Prospective Longitudinal Study. Cleft Palate Craniofac J 2023:10556656231199840. [PMID: 37728101 DOI: 10.1177/10556656231199840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To reflect upon our non-surgical respiratory management by evaluating clinical outcomes regarding airway, feeding, and growth during the first year of life in patients with Robin Sequence. DESIGN Prospective study. SETTING Sophia Children's Hospital, Rotterdam, the Netherlands. PATIENTS/ PARTICIPANTS 36 patients with Robin Sequence who were treated between 2011 and 2021. INTERVENTIONS Positional therapy and respiratory support. MAIN OUTCOME MEASURE(S) Data on respiratory outcomes included polysomnography characteristics and capillary blood gas values. Feeding outcomes were based on the requirement of additional tube feeding. Outcomes on growth were expressed as standard-deviation-scores (SDS) for weight-for-age (WFA) and height-for-age (HFA). RESULTS Twenty patients were treated with positional therapy (PT), whilst the other 16 patients required respiratory support. Twenty-two patients presented with non-isolated Robin Sequence (RS). During the first year of life, obstructive apnea hypopnea index decreased, oxygen levels enhanced, and capillary blood gas values improved. Eighty-six percent (31/36) experienced feeding difficulties, which completely resolved in 71% (22/31) during their first year of life. From start treatment, to stop treatment, to the age of 1 year, the SDS WFA worsened from -0.40 to -0.33 to -1.03, respectively. CONCLUSIONS Non-surgical respiratory treatment resulted in an improvement of respiratory outcomes to near normal during the first year of life in patients with RS. These patients often experience feeding difficulties and endure impaired weight gain up to 1 year of age, despite near normalization of breathing. The high prevalence of feeding difficulties and impaired weight for age indicate the urgency for early recognition and adequate treatment to support optimal growth.
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Affiliation(s)
- Pleun P J M van der Plas
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gwen G M van Heesch
- Department of Pediatric Intensive Care, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bas Pullens
- Department of Otorhinolaryngology, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irene M J Mathijssen
- Department of Plastic and Reconstructive Hand Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Simone E Bernard
- Department of Otorhinolaryngology, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
| | - Koen F M Joosten
- Department of Pediatric Intensive Care, Sophia Children's Hospital - Erasmus Medical Center, Rotterdam, The Netherlands
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Sullivan NAT, Smit JA, Lachkar N, Logjes RJH, Kruisinga FH, Reinert S, Persson M, Davies G, Breugem CC. Differences in analysis and treatment of upper airway obstruction in Robin sequence across different countries in Europe. Eur J Pediatr 2023; 182:1271-1280. [PMID: 36633656 DOI: 10.1007/s00431-022-04781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
The goal of this study was to explore the availability of diagnostic and treatment options for managing upper airway obstruction (UAO) in infants with Robin Sequence (RS) in Europe. Countries were divided in lower- (LHECs, i.e., PPP per capita < $4000) and higher-health expenditure countries (HHECs, i.e., PPP per capita ≥ $4000). An online survey was sent to European healthcare professionals who treat RS. The survey was designed to determine the availability of diagnostic tools such as arterial blood gas analysis (ABG), pulse oximetry, CO2 analysis, polysomnography (PSG), and sleep questionnaires, as well as to identify the used treatment options in a specific center. Responses were received from professionals of 85 centers, originating from 31 different countries. It was equally challenging to provide care for infants with RS in both LHECs and HHECs (3.67/10 versus 2.65/10, p = 0.45). Furthermore, in the LHECs, there was less access to ABG (85% versus 98%, p = 0.03), CO2 analysis (45% versus 70%, p = 0.03), and PSG (54% versus 93%, p < 0.01). There were no significant differences in the accessibility concerning pulse oximetry, sleep questionnaires, home saturation monitoring, nasopharyngeal tubes, Tuebingen plates, and mandibular distraction. Conclusion: This study demonstrates a large difference in available care for infants with RS throughout Europe. LHECs have less access to diagnostic tools in RS when compared to HHECs. There is, however, no difference in the availability of treatment modalities between LHECs and HHECs. What is Known: • Patients with Robin sequence (RS) require complex and multidisciplinary care. They can present with moderate to severe upper airway obstruction (UAO). There exists a large variety in the use of diagnostics for both UAO treatment indications and evaluations. In most cases, conservative management of UAO in RS is sufficient. Patients with UAO that persist despite conservative management ultimately need surgical intervention. To determine which intervention is best suitable for the individual RS patient, the level of UAO needs to be determined through diagnostic testing. • There is a substantial variation among institutions across Europe for both diagnostics and treatment options in UAO. A standardized, internationally accepted protocol for the assessment and management of UAO in RS could guide healthcare professionals in the timing of assessment and indications to prevent escalation of UAO. Creating such a protocol might be a challenge, as there are large financial differences between countries in Europe (e.g., health expenditure per capita in purchasing power parity in international dollars ranges from $600 to over $8500). What is New: • There is a substantial variation in the availability of objective diagnostic tools between European countries. Arterial blood gas analysis, CO2 analysis and polysomnography are not equally accessible for lower-healthcare expenditure countries (LHECs) compared to higher-healthcare expenditure countries (HHECs). These differences are not only limited to availability; there is also a difference in quality of these diagnostic tools. Surprisingly, there is no difference in access to treatment tools between LHECs and HHECs. • There is national heterogeneity in access to tools for diagnosis and treatment of RS, which suggests centralization of health care, showing that specialized care is only available in tertiary centers. By centralization of care for RS infants, diagnostics and treatment can be optimized in the best possible way to create a uniform European protocol and ultimately equal care across Europe. Learning what is necessary for adequate monitoring could lead to better allocation of resources, which is especially important in a low-resource setting.
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Affiliation(s)
- Nathaniel A T Sullivan
- Department of Plastic Surgery, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Johannes A Smit
- Department of Plastic Surgery, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Nadia Lachkar
- Department of Plastic Surgery, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Robrecht J H Logjes
- Department of Plastic Surgery, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Frea H Kruisinga
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Department of Pediatrics, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, Tuebingen University Hospital, Osianderstrasse 2-8, Tuebingen, 72076, Germany
| | - Martin Persson
- Faculty of Health Science, Kristianstad University, Elmetorpsvägen 15, Kristianstad, 291 39, Sweden
| | - Gareth Davies
- European Cleft Organisation, Verrijn Stuartlaan 28, Rijswijk, ZH, 2288 EL, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic Surgery, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
- Department of Pediatrics, Amsterdam UMC, Location University of Amsterdam, Emma Childrens Hospital, Meibergdreef 9, Amsterdam, The Netherlands.
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Blanc F, Harrewijn I, Duflos C, Maggiulli F, Captier G. Nasopharyngeal Tube and Functional Treatment in Pierre Robin Sequence: A Tertiary Clinical Experience From 150 Cases. Cleft Palate Craniofac J 2021; 59:891-898. [PMID: 34313144 DOI: 10.1177/10556656211031105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe the initial care practices for children with Pierre Robin sequence (PRS) and analyze the factors predicting the severity of the obstruction breathing disorders. DESIGN A retrospective single-center study of 150 children with PRS. SETTING Single tertiary care center, Regional Competence Center for the diagnosis and treatment of PRS. PATIENTS A total of 150 children with PRS consecutively followed between 1986 and 2017. Group 1 comprises children without specific respiratory management; group 2, children requiring prone positioning to alleviate their respiratory distress symptoms; and group 3, children requiring nasopharyngeal airway tube (NT) or nonconservative surgical treatment. MAIN OUTCOME MEASURES Evolution and results of the initial treatment of PRS. RESULTS Forty-two percent (n = 63) were attributed to group 1, 39% (n = 50) to group 2, and 19% (n = 29) to group 3. Preterm birth, birth weight, or associated congenital malformations were not significantly different between the groups. However, the age of exclusive oral feeding was significantly different: 1 day (quartiles: 0-3) for group 1; 11 days (quartiles: 1-28) for group 2; 39 days (quartiles: 19-111) for group 3 (P < .0001). Considering the NT, its use relieves the upper airway obstruction, assessed by a respiratory polygraphy, in 14 children. CONCLUSIONS Nasopharyngeal airway tube has become our major first-line treatment, avoiding more complex procedures in most of the cases. The achievement of exclusive oral feeding seems to be a good predictor of the severity of respiratory symptoms in PRS.
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Affiliation(s)
- Fabian Blanc
- Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Inge Harrewijn
- Neonatal Intensive Care Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Claire Duflos
- Department of Medical Information, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Frederica Maggiulli
- Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France
| | - Guillaume Captier
- Pediatric Orthopedic Plastic Surgery Unit, Montpellier University Hospital, University of Montpellier, Lapeyronie Hospital, Montpellier, France.,School of Medicine, University of Montpellier, Montpellier, France
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Oh MS, Park YM, Jung YH, Choi CW, Kim BI, Kwon JW. Three Cases of Pierre Robin Sequence with Upper Airway Obstruction Relieved by Nasopharyngeal Airway Insertion. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.3.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Demoro CCDS, Fontes CMB, Trettene ADS, Cianciarullo TI, Lazarini IM. Applicability of Orem: training of caregiver of infant with Robin Sequence. Rev Bras Enferm 2019; 71:1469-1473. [PMID: 29972549 DOI: 10.1590/0034-7167-2016-0562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/05/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to report the nurses' experience in relation to the training of caregivers of infants with Isolated Robin Sequence (IRS) for maintaining care after hospital discharge from the perspective of Self-Care Theoretical Framework. METHOD the following categories were considered in this experience report: self-care action, self-care capacity, therapeutic self-care demand, self-care deficit, and nursing system. The nursing system was wholly compensatory and supportive-educative. RESULTS caregivers' training by nurses results in the acquisition of technical skills and specific knowledge related to the infant's positioning in elevated ventral decubitus, nasopharyngeal intubation, feeding-facilitating techniques and care with the feeding tube. FINAL CONSIDERATIONS the continuity of home care is guaranteed from caregivers' training for the therapeutic demand.
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The Effect of Mandibular Distraction Osteogenesis on Weight Velocity in Infants With Severe Pierre Robin Syndrome. J Craniofac Surg 2018; 29:1851-1854. [DOI: 10.1097/scs.0000000000004650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cephalometric Findings in Nine Individuals With Richieri-Costa-Pereira Syndrome. J Craniofac Surg 2018; 29:1596-1600. [DOI: 10.1097/scs.0000000000004588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Trettene ADS, Fontes CMB, Razera APR, Prado PC, Bom GC, von Kostrisch LM. Sizing of nursing staff associated with self-care promotion in a pediatric semi-intensive care unit. Rev Bras Ter Intensiva 2017; 29:171-179. [PMID: 28977258 PMCID: PMC5496751 DOI: 10.5935/0103-507x.20170027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/09/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To calculate and compare the nursing staff size associated with self-care promotion at a pediatric semi-intensive care unit. METHODS This was a prospective study in which 31 children and their caregivers participated. The nursing workload associated with each participant was evaluated at two different times (first and second hospital stays) using the Nursing Activities Score instrument. The first hospital stay corresponded to self-care promotion. Staff size was calculated according to the nursing hours recommended by the Nursing Activities Score instrument and by Conselho Federal de Enfermagem (COFEN) resolution no. 527/16, in the two hospital stays, and the results were compared. RESULTS The nursing workload in the first hospital stay (14.6 hours) was higher than the nursing workload in the second stay (9.9 hours) (p < 0.001). The Nursing Activities Score revealed that according to the nursing hours, the nursing staff size corresponded to 26 and 18 professionals in the first and second hospital stays, respectively, and to 15 professionals according to COFEN resolution no. 527/16. CONCLUSION The number of personnel responsible for promoting self-care in pediatric semi-intensive care units, according to the nursing hours suggested by the Nursing Activities Score, was higher than that recommended by the existing legislation. This demonstrates the necessity of reconsidering staff size for this healthcare profile.
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Affiliation(s)
- Armando dos Santos Trettene
- Programa de Pós-Graduação em Ciências
da Reabilitação, Hospital de Reabilitação de Anomalias
Craniofaciais, Universidade de São Paulo - Bauru (SP), Brasil
| | | | - Ana Paula Ribeiro Razera
- Programa de Pós-Graduação em Ciências
da Reabilitação, Hospital de Reabilitação de Anomalias
Craniofaciais, Universidade de São Paulo - Bauru (SP), Brasil
| | - Priscila Capelato Prado
- Programa de Pós-Graduação em Ciências
da Reabilitação, Hospital de Reabilitação de Anomalias
Craniofaciais, Universidade de São Paulo - Bauru (SP), Brasil
| | - Gesiane Cristina Bom
- Programa de Pós-Graduação em Ciências
da Reabilitação, Hospital de Reabilitação de Anomalias
Craniofaciais, Universidade de São Paulo - Bauru (SP), Brasil
| | - Lilia Maria von Kostrisch
- Programa de Pós-Graduação em Ciências
da Reabilitação, Hospital de Reabilitação de Anomalias
Craniofaciais, Universidade de São Paulo - Bauru (SP), Brasil
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Trettene ADS, Fontes CMB, Razera APR, Gomide MR. Impact of promoting self-care in nursing workload. Rev Esc Enferm USP 2016; 50:635-641. [DOI: 10.1590/s0080-623420160000500014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 05/24/2016] [Indexed: 11/21/2022] Open
Abstract
Abstract OBJECTIVES To assess the impact of promoting self-care in nursing workload and associate it to the variables: age, gender, socioeconomic status, education, marital status and number of children of caregivers. METHODS Prospective study with 31 children and their caregivers. Participants were assessed at two moments, 1st and 2nd hospitalization, the nursing workload was measured by the Nursing Activities Score (NAS). RESULTS The mean NAS in the 1st hospitalization was 60.9% and in the 2nd hospitalization was 41.6%, that is, 14.6 and 9.9 hours of nursing, respectively. The nursing workload on the first day of hospitalization was higher compared to the last day, both for the 1st (p<0.001) and for the 2nd hospitalization (p<0.001), and higher in the first (p<0.001) and in the last day (p=0.025) in the 1st hospitalization. Comparing the 1st hospitalization to the 2nd hospitalization, the first was higher (p<0.001), and NAS items related to the training of self-care was influenced (p<0.001). CONCLUSION The nursing workload associated to self-care promotion corresponded to 14.6 hours and was higher than determined by the existing legislation.
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