Treatment for early-onset neonatal sepsis.

Up to one in 10 neonates are investigated and treated for neonatal sepsis, although most are later found to be uninfected. This review discusses identifying and treating this emergency condition and how implementing NICE guidance could reduce treatment time in well babies and saveonatal sepsis resources without compromising care.

Ingestion or aspiration of foreign bodies by children.

Ingestion and aspiration of foreign bodies are common reasons for children presenting to emergency departments. A significant proportion of such events are often unnoticed by the children's parents or carers. Emergency nurses should become suspicious of foreign body ingestion or aspiration if they see symptoms such as stridor, gagging, wheeze and difference in air entry on auscultation ( Hilliard et al 2003 , Paul et al 2010 ). If they suspect airway compromise, or bowel problems such as perforation or obstruction, the children concerned should be dealt with immediately. Definitive management for foreign body removal is generally available at tertiary centres and children should be transferred to specialist services as soon as possible after stabilisation ( McConnell 2013 ). Before discharge, their parents should be educated about possible signs of deterioration and advised about home-safety measures ( Paul and Wilkinson 2012 ).

Caring for young adults on a paediatric ward.

The need for adolescents and young adults (AYA) to have suitable age-specific inpatient facilities has been recognised for many years, yet has received relatively little attention. This article reports the successful introduction of an inpatient facility for AYA, aged 17-24 years, on a general paediatric ward in a small district general hospital. From December 2010, a young person's unit (YPU) consisting of an 8-bed area was opened within a 24-bed children's ward. Nursing care was provided by the ward staff, all of whom had been trained in the care of young adults. Policies regarding admission criteria, safeguarding, patient choice, visiting and 'house rules' were drafted, implemented and modified as necessary. Discussions with the adult clinicians (for medical care) and site managers were held to ensure smooth running of the system, and to address any concerns or difficulties. Paediatric patients had priority of admission at times of bed crisis. During 2012, there were a total of 2351 inpatient admissions to the paediatric ward, of whom 379 (16%) were YPU patients aged from 17-24 years. Median length of stay was 2 days for patients aged 17-24 years as compared with 1 day for patients aged less than or equal to 16 years. Patients who chose admission to the paediatric ward tended to be younger, in transition from paediatric to adult services for chronic conditions, or with special needs. Patient surveys showed a high level of satisfaction with the facility. Young adults can be cared for safely and effectively on a paediatric ward with minimal additional costs. The essential ingredients for success include discussion with affected parties to address specific concerns, and the establishment of a clear, simple and unambiguous admission policy.

Diagnosing and managing invasive meningococcal disease in children.

In developed countries, invasive meningococcal disease (IMD) is a leading infectious cause of death among children. In the UK, Neisseria meningitidis serogroup B is the most frequently identified cause of IMD. This article describes a clinical audit in which early management of IMD is compared with recommendations in the relevant guidelines. It confirms the importance of early recognition of IMD and the need to review previous, less serious diagnoses in ill children. Emergency department nurses play a vital role in the early recognition and management of IMD. Introduction of a meningococcal B vaccine is likely to benefit children in the UK.

A child with high fever: Kawasaki disease.

Kawasaki disease (KD) is a systemic vasculitis and it predominantly affects young children. Fever with rash is a common presentation in children and is mostly due to a viral illness needing symptomatic treatment. However, KD should be considered if the child has a high fever lasting for more than 5 days and has got other cardinal features of KD. It is important to get the diagnosis correct as cardiac complications can only be reduced when intravenous immunoglobulin is administered within a critical time frame (maximum 10 days) from the onset of the illness. Nurses play a vital role in managing and supporting children and their families, both in the community and the hospital setting.