Highlights from this issue
Some of you will receive this edition on holiday: some of you will have had to delay long yearned for breaks after your children’s schools have gingerly put their toes in the lockdown twilight era. But, rather than dwell on pandemic related uncertainty which we’ve all been submerged for several months, let’s briefly put the microscope somewhere else. Biliary atresia Despite repeated emphasis of the potential implications of prolonged, conjugated, hyperbilirubinaemia and the importance of stool colour, rates of late detected biliary atresia in high income countries have remained effectively static. Untreated, biliary atresia leads to liver failure and death: early palliative surgery in the form of the time honoured Kasai procedure prolongs transplant free survival by years, though the traditional rather arbitrary 2 month cut-off for the procedure is now widely felt to be too relaxed. The clinical assessment approach, in short is alone insufficient, and improved screening...
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Prompt diagnosis of biliary atresia: education has not succeeded, time to move to universal screening
Biliary atresia (BA) is an important public health issue because of its severity, remaining the the most common indication for paediatric liver transplantation, and the time-sensitive nature of its management. The aetiology of BA remains elusive, but it develops prenatally and progresses rapidly after birth. It presents with neonatal jaundice, often as prolongation of physiological jaundice. Affected infants often appear superficially well with normal early growth, although hepatomegaly is common if actively sought. Pale stools are usually present by 2 weeks and are the rule by 1 month of age. Treatment is with a timely Kasai portoenterostomy which, if successful in clearing jaundice, transforms the outlook and postpones the need for urgent liver transplantation, often for many years. The traditional target was to ensure the Kasai was carried out before 60 days old, but it is now evident that it should be done as early as possible to maximise...
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WHO hospital care for children guidelines: what do users need?
In 2020, the World Health Organization is revising the Pocketbook of Hospital Care for Children,1 and we need your input. The Pocketbook of Hospital Care for Children contains guidelines for the management of common childhood illnesses. The target audience is non-specialist or junior doctors or clinical officers, paediatric and general nurses and other healthcare workers who find themselves providing care for sick children in settings such as at district or provincial hospitals in low-income and middle-income countries. It is not a textbook of paediatrics, but an evidence-based practical clinical guideline. We want to know what you like about the book, where there are gaps, whether new diseases or conditions should be included, and whether any differences in formatting or structure or companion resources would make it easier to use. We seek your input on what, when and for whom a physical book is still useful, and for...
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Antibiotic use in children hospitalised with pneumonia in Central Vietnam
Background and objectives Excessive use of antibiotics has been noted in children with respiratory tract infections in Vietnam, but antibiotic use in hospitalised children is poorly documented. Antibiotic use and direct healthcare costs in children hospitalised with pneumonia in central Vietnam were assessed. Methods A prospective descriptive study of children under 5 years old admitted with a primary admission diagnosis of ‘pneumonia’ to the Da Nang Hospital for Women and Children over 1 year. Results Of 2911 children hospitalised with pneumonia, 2735 (94.0%) were classified as ‘non-severe’ pneumonia by the admitting physician. In total, 2853 (98.0%) children received antibiotics. Intravenous antibiotics were given to 336 (12.3%) children with ‘non-severe’ and 157/176 (89.2%) children with ‘severe’ pneumonia; those with ‘non-severe’ pneumonia accounted for 68.2% (336/493) of intravenous antibiotics given. Only 19.3% (95/493) of children on intravenous antibiotics were stepped down to an oral antibiotic. Cefuroxime was the preferred oral agent, and ceftriaxone was the preferred injectable agent. Hospital admission for oral antibiotics in ‘non-severe’ pneumonia was a major cost driver, with an average direct cost of US$78.9 per patient, accounting for 54.0% of the total hospitalisation cost in the study cohort. In addition, 336 (12.3%) children with non-severe pneumonia received intravenous antibiotics without indication, accounting for a further 23.2% of hospitalisation costs. Conclusion Limiting unnecessary hospitalisation and considering early intravenous to oral step down antibiotic will reduce direct health system costs and morbidity in children with respiratory tract infections in Vietnam.
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