Medical record review of deaths, unexpected intensive care unit admissions, and clinician referrals: detection of adverse events and insight into the system.

AIMS AND METHODS: To determine whether a programme of continuous medical record review of deaths, unexpected intensive care unit (ICU) admissions, and admissions referred by medical and nursing staff for specific review, would provide a range of adverse events from which to gain insight into the healthcare system of a large paediatric referral hospital. A quality assurance programme was commenced in 1996. RESULTS: Over a six year period there were 103 255 admissions; 1612 (1.6%) records were reviewed, from which 325 adverse events were detected. Events were associated with operations, procedures and anaesthesia (56.5%), diagnosis and therapy (24%), drug and fluid management (12.6%), and system issues (7%). Medical records were reviewed from 23 of the 28 clinical units. Review of the records and analysis of the adverse events triggered many system changes. CONCLUSIONS: The findings suggest that continuous medical record review may be a valuable method for the detection of adverse events and identifying system issues in children's hospitals.

Delayed left ear accuracy during childhood and early adolescence as indicated by Roberts' Dichotic Word Listening Test.

A total of 200 girls and boys between the ages of 6 years and 15 years were administered Roberts' Dichotic Word Listening Test. A statistically significant relatively abrupt and maintained increase in left ear accuracy was noted after 9 years of age (eta = .55). Except for a mild improvement after 6 to 7 years of age, comparable changes were not observed for the right ear. The magnitude of the effect was not significantly diminished even after covariance for verbal fluency and semantic categorization. These results are compatible with the observations that myelination of the cerebral commissures and electroencephalographic phase relations of the right hemisphere achieve near-adult characteristics after 9 years of age. Boys displayed less accuracy for dichotic word listening, particularly for the left ear, compared to the girls eta = .20).

Nocturnal enuresis: what is happening?

Primary nocturnal enuresis is common and has considerable psychological ramifications for children as they get older. It is a familial condition with complex inheritance patterns. The pathophysiology of the condition appears to be related to poor arousal from sleep, nocturia due to deficient vasopressin release in sleep and possibly a decrease in functional bladder capacity especially at night. The mainstay of treatment is the bed-wetting alarm. In recent years, desmopressin nasal spray has found a clinical niche as a short-term solution for children attending school camps or sleeping over at friends' houses and as treatment in the medium term for those unresponsive to treatment with a bed-wetting alarm. It may also be used as an adjunct to the use of the alarm. Treatment with imipramine is increasingly in disfavour because the relapse rate is unacceptably high and fatal overdose is a real possibility.

Feeding difficulties. Part 1. Breast feeding.

Breast feeding is a learned process and often poses difficulties for new mothers. Time spent managing breast feeding difficulties with accurate advice and a compassionate ear will be rewarded with a greater percentage of infants in our community being fed the most appropriate milk for them.

Feeding difficulties. Part 2. Artificial feeding.

It is vital that GPs resist the temptation to change the type of formula being fed to an infant without a clear indication. In addition to the confusion it creates for mothers and infants, it is potentially hazardous.

Health screening of international adoptees. Evaluation of a hospital based clinic.

OBJECTIVE: To report the findings of health screening of 100 international adoptees. DESIGN: Retrospective case review. SETTING AND PATIENTS: The first 100 children to attend the Outpatient Inter-Country Adoption Clinic at the Royal Children's Hospital, Melbourne. INTERVENTIONS: A medical history was taken and a thorough physical examination and series of screening investigations were performed on all children. RESULTS: The children ranged in age from two months to 16 years (median, five months; mean, 2.8 years). The countries most represented were Korea, with 36 children, and India, with 21. Thirty children fell below the third Australian centile for both height and weight. Abnormalities on physical examination included hepatosplenomegaly (13 children), scabies (six) and severe dental caries (six). Parasitic infestation of the stools was found in 23 children, a positive Mantoux test result in nine (three had active tuberculosis), anaemia in 12, elevated hepatic transaminase levels in nine and positive hepatitis B surface antigen and e antigen in two. One child had acquired syphilis. Screening for human immunodeficiency virus antibody gave negative results in all children. CONCLUSION: International adoptees constitute a special paediatric subgroup requiring assessment and screening investigations as soon as possible after arrival in their adoptive country.

PIP: This retrospective case review sought to report the findings of a health screening of 100 international adoptees. Included were the 1st 100 children who attended the Outpatient Inter-Country Adoption Clinic at the Royal Children's Hospital in Melbourne. A medical history was taken and a thorough physical examination and series of screening investigations were performed on all children. The children range in age from 2 months-16 years (median=5 months; mean=2.8 years). The countries most represented were Korea with 36 children and India with 21. 30 children fell below the 3rd Australian centile for both height and weight. Abnormalities on physical examination included hepatosplenomegaly (13 children), scabies (6), and severe dental caries (6). Parasitic infestation of the stools was found in 23 children, a positive Mantoux test result in 9 (3 with active tuberculosis), anemia in 12, elevated hepatic transaminase levels in 9, and positive hepatitis B surface antigen and e antigen in 2. I child had acquired syphilis. Screening for human immunodeficiency virus antibody gave negative results in all children. These international adoptees constitute a special pediatric subgroup which require assessment and screening as soon as possible after arrival in their adoptive country.

Positive end expiratory pressure via a portable system in thoracic dystrophy.

The provision of positive end expiratory pressure, via a unique portable system, in the long term management of a child with thoracic dystrophy is reported. The system uses low gas flow enabling a reduction in equipment and simplification of the circuit as compared with a standard continuous positive airways pressure system.

D-Lactate associated encephalopathy in short bowel syndrome: management with long-term non-absorbable oral antimicrobials.

We describe a child with short bowel syndrome consequent upon jejunal atresia who developed recurrent episodes of D-Lactate associated encephalopathy. Three species of lactobacillus were isolated from the stool, each sensitive to neomycin. Oral neomycin administration resulted in rapid relief of all symptoms. Cessation of the neomycin on two occasions led to recurrent encephalopathic episodes which quickly resolved with recommencement of treatment. We discuss the possible aetiologies of this encephalopathy syndrome and the therapeutic options.

Methaemoglobinaemia after ingestion of amyl nitrite.

We report a case of methaemoglobinaemia in a 2 year old girl after ingestion of an 'aphrodisiac' containing nitrite. The availability of these products, their poor labelling, and their intended presence in domestic bedrooms all serve to increase the hazard they pose to young children.