A validated Screening instrument for Child Abuse and Neglect (SCAN) at the emergency department.

The objective of this study is to develop and validate a screening instrument for the recognition of child maltreatment in the emergency department (ED). Existing data on screening questions and outcomes (diagnosis of child maltreatment) from three large observational screening studies at eight different EDs in the Netherlands were harmonized. A multivariate logistic regression was performed to develop the Screening instrument for Child Abuse and Neglect (SCAN). The SCAN was validated by performing a cross-validation and calculating the discriminative ability. A total of 24,963 patients were included. Out of the potential screening questions the following questions were included in the final instrument: is the injury compatible with the history, and does it correspond to the child's developmental level? (aOR 10.40, 95% CI 5.69-19.02), was there an unnecessary delay in seeking medical help? (aOR 3.45, 95% CI 1.73-6.88) and is the behaviour/interaction of the child and parents (carers) appropriate? (aOR 14.67, 95% CI 7.93-27.13). The SCAN had a pooled AUC of 0.75 (95% CI 0.63-0.87) in the cross-validation. The question "Are there other signals that make you doubt the safety of the child and/or family?" (available in only one of the original datasets, OR 182.9; 95% CI 102.3-327.4) was by consensus added to the final SCAN. CONCLUSION: This validated and brief Screening instrument for Child Abuse and Neglect (SCAN) is designed to improve early recognition of child maltreatment in the ED. A positive screening result of the SCAN warrants a thorough work-up for child maltreatment, including a top-toe examination, if necessary additional diagnostics and adequate safety measures. WHAT IS KNOWN: • Screening instruments increase the detection of possible cases of child maltreatment in the emergency department and support health care professionals to identify these cases. • The application of different screening instruments led to the need for one brief validated instrument. WHAT IS NEW: • This study presents a validated and brief Screening instrument for Child Abuse and Neglect (SCAN), consisting of four questions. • The SCAN supports professionals in detecting signals of child maltreatment, and a positive screening result should lead to a thorough work-up, including a top-toe examination, complete history, additional diagnostic tests and consultation of a child abuse expert.

[Screening for child abuse at emergency rooms is useful]. / Screening kindermishandeling op SEH toch nuttig.

In the Netherlands screening of child abuse is obligatory at emergency departments. In spite of the modest detection rate, in our opinion there is sufficient evidence and reason to continue screening.

Carnitine deficiency in surgical neonates receiving total parenteral nutrition.

Carnitine plays a key role in the oxidation of fatty acids. Most solutions for parenteral nutrition do not contain carnitine. Because endogenous carnitine synthesis is insufficient in newborns, they are prone to developing a carnitine deficiency when they are dependent on total parenteral nutrition (TPN). Stimulated by the clinical observation of manifest clinical symptoms of carnitine deficiency in one patient, a study of 13 consecutive neonates who received TPN for over 2 weeks was begun. Their plasma carnitine levels before and during carnitine supplementation were determined. All patients had a carnitine intake far below the recommended minimal need of 11 mumol/kg per day. Although only three of them clearly showed clinical symptoms described as carnitine deficiency, carnitine supplementation for all neonates receiving TPN for over 2 weeks is recommended.

[Psychosocial aspects of the so-called short-bowel syndrome in children]. / Psychosociale aspecten van het zogenaamde korte-darmsyndroom bij kinderen.

In a retrospective study of 16 patients with (congenital) bowel pathology, aged 2 to 12, attention was paid to the psychosocial aspects of the short bowel syndrome. Parents were interviewed and parents' and teachers' reports of children's behavioural and emotional problems were obtained. Parents as well as children appeared to have reached a reasonable level of adjustment. Parents' emotions concerning the period of hospitalisation still appeared to be strikingly strong. Although most children did not show obvious psychopathology, problems were observed in the areas of behaviour and attention, interfering with optimal school functioning in the case of some children.

Bowel resection in the neonatal phase of life: short-term and long-term consequences.

Bowel resection during the neonatal phase of life may be associated with considerable morbidity, both short- and long-term. A retrospective evaluation is reported, concerning 74 patients who underwent bowel resection over a ten-year-period, due to necrotising enterocolitis, atresia, volvulus or Hirschsprung's disease. The cause of death of 15 non-survivors was investigated and the pattern of morbidity of 59 surviving patients was evaluated regarding growth, nutrition and defaecation. It was concluded that the ultimate prognosis for most patients is good, despite considerable morbidity during the first year of life, involving serious losses of fluids and electrolytes, cholestasis, and recurrent sepsis due to central venous catheters.

[Short bowel syndrome]. / Het korte darmsyndroom.

The short bowel syndrome is a clinical picture, consisting of malabsorption and failure to thrive, in consequence of a resection of more than 50% of the small bowel, with or without resection of a part of the colon. The etiology, pathophysiology, treatment and natural history are discussed, as well as complications and ultimate prognosis. A review of the literature and own retrospective investigation prove, that after an extensive small bowel resection in the neonatal period, normal stools, growth and development can occur in 1-3 years. In the first, postoperative period however, these patients suffer from considerable malabsorption, deficiencies of vitamins and trace elements, as well as complications of total parenteral nutrition and recurrent infections.

Lung function and bronchial responsiveness in children who had infantile bronchiolitis.

A number of studies have shown that children who had infantile bronchiolitis are at increased risk of recurrent episodes of wheezing. A genetic predisposition to atopy is mentioned in some studies and is contested by others. Lung function abnormalities and increased bronchial responsiveness (BR) have been described after infantile bronchiolitis. We investigated children who had had the clinical syndrome of bronchiolitis during infancy and compared them with asthmatic and healthy children of the same age regarding bronchial caliber, smooth muscle tone, and responsiveness to histamine. Lung function was measured by forced oscillometry. We found that most children with current symptoms had either decreased baseline bronchial caliber, increased bronchial smooth muscle tone, or increased BR. These patients are comparable to mild asthmatics. The children without current symptoms are comparable to healthy children in these respects. Recurrent respiratory symptoms after bronchiolitis should be regarded as mild asthma and treated as such.