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Borko UD, Gelgelu TB, Zema Z, Alemu A, Dendir G, Israel E, Abiso TL, Woldegeorgis BZ. Determinants of mortality among pediatric patients admitted to Wolaita Sodo University Comprehensive Specialized Hospital with acute bacterial meningitis, Southern Ethiopia: an unmatched case-control study. BMC Pediatr 2023; 23:610. [PMID: 38044442 PMCID: PMC10694971 DOI: 10.1186/s12887-023-04410-6] [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: 06/07/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND People of all ages suffer from acute bacterial meningitis, but children are the most vulnerable, accounting for over 50% of all cases and deaths in children under the age of five. It is the leading cause of morbidity, mortality, and long-term suffering worldwide. Children are at great risk of disease and mortality due to a lack of specific immunity associated with their young age. As a result, determinants of death were found among pediatric patients treated with acute bacterial meningitis at Wolaita Sodo University Comprehensive Specialized Hospital in Southern Ethiopia. METHODS A facility-based unmatched case-control study was conducted on pediatric patients admitted with acute bacterial meningitis at Wolaita Sodo University Comprehensive Specialized Hospital from July 1, 2019, to June 30, 2022. A total of 355 (71 cases and 284 controls) pediatric medical charts were used for data extraction using a preestablished checklist. Data were checked for completeness and consistency, entered into Epi-Data version 4.6 software, and transported to SPSS version 25 for analysis. Multivariable logistic regression analysis was performed to identify the independent determinants of acute bacterial meningitis mortality at a P value of < 0.05 along with a 95% confidence interval (CI). RESULTS Age between 2 months and 5 years (adjusted odds ratio (AOR) = 3.19, 95% CI = 1.15-8.88), admission in the summer season (AOR = 0.27, 95% CI = 0.15-0.49), and family size greater than or equal to six (AOR = 3.13, 95% CI = 1.76-5.56), initial antibiotic change (AOR = 10.81, 95% CI = 2.10-55.7), clinical features at presentation such as loss of consciousness (AOR = 16.90, 95% CI = 4.70-60.4), abnormal body movements (seizures) (AOR = 6.51, 95% CI = 1.82-23.4), increased intracranial pressure (AOR = 3.63, 95% CI = 1.78-7.4), malnutrition (AOR = 2.98, 95% CI = 1.34-6.59) and presence of more than one comorbidity (AOR = 3.03, 95% CI = 1.03-9.03) were found to be determinants of acute bacterial meningitis mortality. CONCLUSIONS In summary, children aged 2 months to 5 years from large families ( > = 6) with a history of initial antibiotic change, malnutrition, more than one comorbidity, and worse clinical characteristics were related to greater death due to acute bacterial mortality in this study.
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Affiliation(s)
- Ushula Deboch Borko
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Temesgen Bati Gelgelu
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Zewde Zema
- School of Pharmacy, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Afework Alemu
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getahun Dendir
- School of Anesthesia, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Eskinder Israel
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Temesgen Lera Abiso
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Beshada Zerfu Woldegeorgis
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Ogino J, Hilado M, Schellenberg M, Im DD. Pain Management in Pediatric Trauma. Clin Pediatr (Phila) 2022; 61:821-825. [PMID: 35746870 DOI: 10.1177/00099228221106469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jayme Ogino
- Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA
| | - Mark Hilado
- Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA
| | - Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA
| | - Daniel D Im
- Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.,Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA
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Abstract
OBJECTIVE/METHODS Pediatric Palliative Care (PPC) is a multidisciplinary medical subspecialty focused on the care of children with serious illnesses and terminal diagnoses. Providers impact the care of children from the perinatal stage through adolescence/young adulthood and help patients and families face diagnoses such as complex chronic disease and malignancy. This article describes these unique populations and distinct areas of current PPC research. RESULTS Unique aspects of PPC include a high level of prognostic uncertainty, symptom burden, pediatric, and surrogate advance care planning, hope in the face of prognostic challenges, care of children at end of life, concurrent care, staff support, sibling support, and bereavement. CONCLUSION PPC's evolution from an extension of hospice into a continuum of support for families and staff caring for children with serious illnesses is exemplified in both qualitative and quantitative research. The literature proves the value that PPC can provide to families, hospitals, and communities. PPC is evolving from a supportive service into a uniquely beneficial, collaborative, educational, and interdisciplinary specialty that improves outcomes for all involved.Plain Language Summary (PLS)Pediatric Palliative Care (PPC) is a service provided to all children with serious illness as a way of addressing suffering. Populations served by PPC range from those not yet born to patients preparing for adulthood. The serious illnesses they face range from chronic disease to cancer. Over the last 20 years research has explored the unique aspects of the pediatric experience of serious illness, including prognostic uncertainty, concurrent care, symptom management, advance care planning, hope, family experience of illness, care at the end of life, staff support, and bereavement.As the number of patients who would benefit from PPC services rapidly expands nationally and worldwide, PPC teams provide education and skills training for their colleagues in primary and subspecialty fields. Hospitals benefit from PPC through improved patient experience, family-centered care, and staff support. Communities are served by PPC that occurs in and out of the hospital.Research in PPC provides guidance for challenging questions in care and has resulted in an increasingly robust body of work. PPC providers have skills of advanced communication training, hope in the face of uncertainty, targeted and personalized symptom management, and a diverse understanding of quality of life. These skills help support decision-making and establish strong connections between providers and families.The field of PPC has a distinct skillset to support families who face serious illness. This article helps medical and psychosocial providers visualize how PPC is evolving from what has often been explained to families as an added layer of support into a uniquely beneficial, collaborative, and interdisciplinary service.
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Affiliation(s)
- Benjamin Moresco
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Dominic Moore
- Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Beaudoin ML, Torrents M, Tittarelli MF, Hamui M, Ibarra M, Ferraro M, Ferreira JP. Use of a Flexible Catheter for the Administration of Subcutaneous Insulin in Diabetic Ketoacidosis: A Feasibility Controlled Clinical Trial. Hosp Pediatr 2021; 11:396-400. [PMID: 33687988 DOI: 10.1542/hpeds.2020-0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although intravenous insulin administration is the standard of care in diabetic ketoacidosis (DKA), subcutaneous insulin administration could be a suitable alternative in resource-limited settings, but pain caused by hourly insulin applications are limiting factors for using it, especially in children. We aimed to assess whether the use of a flexible subcutaneous catheter improves comfort in patients with DKA compared with the usual hourly injections' treatment. We also compared the evolution of metabolic variables in patients with DKA using both insulin administration systems. METHODS Randomized feasibility controlled open trial, comparing 2 ways (flexible catheter and steel needle) for the initial insulin administration in children with DKA, who were randomly selected to receive subcutaneous insulin by a flexible catheter or using standard needles. The main outcome was pain, assessed hourly and secondary outcome time to achieve ketoacidosis resolution. RESULTS Twenty subjects were included (10 by group). There were no differences between groups in baseline lab values (glycemia, urea, sodium, bicarbonate and pH). Pain assessment at first insulin administration was significantly lower in the intervention group (4.5 vs 0 points; P = 0.001). Similar differences between both treatment arms were observed in every pain assessment. There were no differences between groups regarding the time elapsed to achieve ketoacidosis resolution. (11.4±4.3 vs 16±8.4; P = 0.12). No adverse events or DKA complications were observed. CONCLUSIONS The use of a flexible catheter reduced the pain associated with subcutaneous insulin administration in nonsevere DKA. The flexible subcutaneous catheter could be a safe alternative for the treatment of uncomplicated DKA in resource-limited settings.
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Affiliation(s)
| | - Milagros Torrents
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | | | - Magali Hamui
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Mariano Ibarra
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Mabel Ferraro
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
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Halpern R. Pediatric Palliative Care for the Primary Care Provider. PHYSICIAN ASSISTANT CLINICS 2020. [DOI: 10.1016/j.cpha.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Purpose of review: Despite advances in technology and treatment options, over 15,000 neonates die each year in the United States. The majority of the deaths, with some estimates as high as 80%, are the result of a planned redirection of care or comfort measures only approach to care. When curative or life-prolonging interventions are not available or have been exhausted, parents focus on preserving quality of life and eliminating needless suffering. Parents hope their child will have a peaceful death and will not feel pain. A significant component of end-of-life care is high quality symptom evaluation and management. It is important that neonatal providers are knowledgeable in symptom management to address common sources of suffering and distress for babies and their families at the end-of-life (EOL). Recent findings: Medically complex neonates with life-threatening conditions are a unique patient population and there is little research on end-of-life symptom assessment and management. While there are tools available to assess symptoms for adolescents and adults, there is not a recognized set of tools for the neonatal population. Nonetheless, it is widely accepted that neonates experience significant symptoms at end-of-life. Most commonly acknowledged manifestations are pain, dyspnea, agitation, and secretions. In the absence of data and established guidelines, there is variability in their clinical management. This contributes to provider discomfort and inadequate symptom control. Summary: End-of-life symptom assessment and management is an important component of neonatal end-of-life care. While there remains a paucity of studies and data, it is prudent that providers adequately manage symptoms. Likewise, it is important that providers are educated so that they can effectively guide families through the dying process by discussing disease progression, physical changes, and providing empathetic support. In this review, the authors make recommendations for non-pharmacological and pharmacological management of end-of-life symptoms in neonates.
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Affiliation(s)
- DonnaMaria E Cortezzo
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Mark Meyer
- Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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Romo RD, Carpenter JG, Buck H, Lindley LC, Xu J, Owen JA, Sullivan SS, Bakitas M, Dionne-Odom JN, Zubkoff L, Matzo M. HPNA 2019-2022 Research Agenda: Development and Rationale. J Hosp Palliat Nurs 2019; 21:E17-E23. [PMID: 31166302 PMCID: PMC6776462 DOI: 10.1097/njh.0000000000000580] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Building on the strong work of previous research agendas (2009-2012, 2012-2015, 2015-2018), the Hospice and Palliative Nurses Association Research Advisory Council developed the 2019-2022 Research Agenda in consultation with Hospice and Palliative Nurses Association (HPNA) membership and assessment of major trends in palliative nursing. The HPNA Research Advisory Council identified 5 priority areas and asked subject experts in each area to summarize the state of the science, identify critical gaps, and provide recommendations for future research. This document expands the executive summary published on the HPNA website (www.advancingexpertcare.org/hpna/) and provides supporting evidence for the 2019-2022 recommendations. The 5 priority areas are as follows: (1) pediatric hospice and palliative nursing research; (2) family caregiving; (3) interprofessional education and collaborative practice; (4) big data science, precision health, and nursing informatics; and (5) implementation science.
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Affiliation(s)
- Rafael D Romo
- Rafael D. Romo, PhD, RN, PHN, is assistant professor of Nursing, University of Virginia School of Nursing, Charlottesville. Joan G. Carpenter, PhD, CRNP, ACHPN, FPCN, is research associate, University of Pennsylvania School of Nursing, and health science specialist, Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia, Pennsylvania. Harleah Buck, PhD, RN, FPCN, FAHA, FAAN, is associate professor and coordinator of Chronic Illness Initiatives, University of Southern Florida, Tampa. Lisa C. Lindley, PhD, RN, FPCN, is associate professor, College of Nursing, University of Tennessee, Knoxville. Jiayun Xu, PhD, RN, is assistant professor, College of Health and Human Sciences, Purdue University School of Nursing, West Lafayette, Indiana. John A. Owen, EdD, MSc, is associate director, Center for Academic Strategic Partnerships for Interprofessional Research and Education (ASPIRE), University of Virginia School of Nursing, Charlottesville. Suzanne S. Sullivan, PhD, MBA, RN, CHPN, is assistant professor, University at Buffalo State University of New York School of Nursing. Marie Bakitas, DNSc, CRNP, NP-C, AOCN, ACHPN, FAAN, is professor and Marie L. O'Koren Endowed Chair in Nursing, University of Alabama at Birmingham School of Nursing. J. Nicholas Dionne-Odom, PhD, MSN, MA, RN, FPCN, is assistant professor of nursing, University of Alabama at Birmingham School of Nursing. Lisa Zubkoff, PhD, is assistant professor of psychiatry, Dartmouth University Geisel School of Medicine and the Dartmouth Institute, Hanover, New Hampshire. Marianne Matzo, PhD, RN, APRN-CNP, AOCNP, AHPCN, FPCN, FAAN, is director of research, Hospice and Palliative Nurses Association, Pittsburgh, PA
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Rico-Mena P, Palacios-Ceña D, Martino-Alba R, Chocarro-Gonzalez L, Güeita-Rodríguez J. The impact of home-based physical rehabilitation program on parents' experience with children in palliative care: a qualitative study. Eur J Phys Rehabil Med 2019; 55:494-504. [PMID: 30781934 DOI: 10.23736/s1973-9087.19.05474-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pediatric palliative care programs aim to improve the quality of life of children with severe life-threatening illnesses, and that of their families. Although rehabilitation and physical therapy provides a valuable tool for the control of symptoms, it has been poorly researched to date. Since the family represents such a fundamental support in these cases, it is important to deepen our understanding regarding the value of implementing rehabilitation programs from the parents' perspective. AIM The aim of this paper was to explore parents' experiences regarding the implementation of a physical rehabilitation program in pediatric palliative care. DESIGN A qualitative methodology was chosen. SETTING The unit of pediatric palliative care at the Hospital Niño Jesús (Madrid, Spain). POPULATION The inclusion criteria were: 1) parents of children, irrespective of their diagnosis; 2) integrated within the program of palliative care at the time of study; 3) aged between 0-18 years; 4) must be receiving Home-Based Rehabilitation Program by the Pediatric Palliative Care team. Fourteen parents were included. METHODS Purposeful sampling method was implemented. Data collection consisted of unstructured and semi-structured interviews. A thematic analysis was performed to interpret transcripts. Guidelines for conducting qualitative studies established by the Consolidated Criteria for Reporting Qualitative Research were followed. RESULTS Three main themes were identified: 1) the meaning of physical rehabilitation to parents; 2) physical rehabilitation as an opportunity for patients to stay in their home environment; and 3) home-based physical rehabilitation as part of the families' social environment. CONCLUSIONS The main needs of a home physical rehabilitation program are to decrease pain and suffering, together with improving family education and training. CLINICAL REHABILITATION IMPACT The experience of rehabilitation programs at home is essential in order to improve both the quality of life and the quality of care of affected children and parents.
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Affiliation(s)
- Patricia Rico-Mena
- Department of Physiotherapy, Podology and Dance, European University of Madrid, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Rey Juan Carlos University, Madrid, Spain - .,Group of Humanities and Qualitative Research in Health Science of Univesidad Rey Juan Carlos (Hum&QRinHS), Madrid, Spain
| | - Ricardo Martino-Alba
- Unit of Pediatric Palliative Care, Niño Jesús Pediatric University Hospital, Madrid, Spain
| | | | - Javier Güeita-Rodríguez
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Rey Juan Carlos University, Madrid, Spain.,Group of Humanities and Qualitative Research in Health Science of Univesidad Rey Juan Carlos (Hum&QRinHS), Madrid, Spain
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Baenziger PH, Moody K. Palliative Care for Children with Central Nervous System Malignancies. Bioengineering (Basel) 2018; 5:bioengineering5040085. [PMID: 30322131 PMCID: PMC6315897 DOI: 10.3390/bioengineering5040085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023] Open
Abstract
Children with central nervous system (CNS) malignancies often suffer from high symptom burden and risk of death. Pediatric palliative care is a medical specialty, provided by an interdisciplinary team, which focuses on enhancing quality of life and minimizing suffering for children with life-threatening or life-limiting disease, and their families. Primary palliative care skills, which include basic symptom management, facilitation of goals-of-care discussions, and transition to hospice, can and should be developed by all providers of neuro-oncology care. This chapter will review the fundamentals of providing primary pediatric palliative care.
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Affiliation(s)
- Peter H Baenziger
- Peyton Manning Children's Hospital, Ascension St. Vincent, 2001 West 86th Street, Indianapolis, IN 46260, USA.
| | - Karen Moody
- MD Anderson Cancer Center, University of Texas, 1515 Holcomb Blvd., Unit 87, Houston, TX 77030, USA.
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