'Baby Liberation' - Developing and implementing an individualised, developmentally-supportive care bundle to critically unwell infants in an Australian Paediatric Intensive Care Unit.

BACKGROUND: Infants requiring high acuity care within a Paediatric Intensive Care Unit are at multifactorial risk of neurological injury to the immature brain, resulting in long-term developmental difficulties. In 2020, Queensland Children's Hospital implemented an individualised family-centred developmental care program, 'Baby Liberation', to address an identified service gap for critically unwell infants, aimed at optimising early neuroprotective strategies and minimising risk of suboptimal developmental outcomes. AIM: To implement Baby Liberation for infants admitted to a quaternary paediatric intensive care referral centre. Secondary aims were to describe environmental changes, enablers and limitations related to implementation. STUDY DESIGN: A single-centre, prospective implementation pilot study investigated the feasibility of implementing Baby Liberation. Subjects included infants less than six months of age admitted to Queensland Children's Hospital Paediatric Intensive Care Unit. OUTCOME MEASURES: Primary measures comprised data collected during the implementation period, including number of eligible patients and number of developmental care plans provided. Environmental audit data were collected pre and post implementation to inform secondary outcomes. RESULTS: Baby Liberation was feasibly implemented into the Queensland Children's Hospital Paediatric Intensive Care Unit. During implementation, 181 individualised care plans were provided to 313 eligible infants (57.8 %). Environmental audits showed improvements in all areas of developmental care, with greatest improvements noted in pain and stress management (+95 %) and staff support and development (+83.3 %). CONCLUSION: Implementation of Baby Liberation was feasible within a large quaternary paediatric intensive care unit and has potential to be expanded into other clinical areas providing acute infant care.

Measuring the effects of airway clearance in mechanically ventilated infants and children: A systematic review.

BACKGROUND: Robust measurement tools are essential in guiding physiotherapy-delivered airway clearance techniques to ventilated infants and children. OBJECTIVE: To identify measurement tools used to evaluate effects of airway clearance techniques in ventilated infants and children and to determine the clinimetric properties of these tools. DATA SOURCES: Pubmed, CINAHL, Embase, The Cochrane Library, Physiotherapy Evidence Database and Web of Science, up to November 2020. STUDY SELECTION: Randomized and non-randomized clinical trials measuring any aspect of lung function during and/or after airway clearance techniques in mechanically ventilated infants and children from birth to sixteen years. DATA EXTRACTION AND DATA SYNTHESIS: Two independent reviewers identified tools measuring effects of airway clearance techniques including secretion clearance, respiratory mechanics, gas exchange and changes on lung imaging. Extracted data included details of the tool, airway clearance intervention being evaluated and aspects of lung function being measured. Assessment of quality and clinimetric properties, including validity, reliability and responsiveness, were evaluated for each tool using the COnsensus-based Standards for the selection of health status Measurement INstruments methodology. RESULTS: Nine measurement tools measured the effects of airway clearance techniques on secretion clearance, respiratory mechanics, gas exchange and lung imaging. Five tools reported clinimetric properties although the yield and overall quality of studies was low. Tools measured many different aspects of lung function. The CO2SMO Plus respiratory mechanics monitor reported the most clinimetric data. LIMITATIONS: Unpublished or in-progress studies were not included to ensure all data collected were peer-reviewed, therefore additional or novel tools may not have been identified. Included age ranges and definition of airway clearance techiques were kept broad to optimise study identification which may limit generalisability of results. CONCLUSION: Measurement tools used by physiotherapists to enhance airway clearance in ventilated infants and children lack high quality evidence of validity, reliability and responsiveness. Measurements gained through these tools should therefore be interpreted with careful consideration until further climimetric evidence is available. CONTRIBUTION OF PAPER.

Congenital Heart Disease Long-term Improvement in Functional hEalth (CHD LIFE): A partnership programme to improve the long-term functional health of children with congenital heart disease in Queensland.

Children who undergo open-heart surgery in the first year of life for congenital heart disease (CHD) are at high-risk for impaired development across multiple domains. International recommendations include systematic periodic developmental surveillance into adolescence and the establishment of long-term follow-up programmes. This article describes the establishment and evolution of the Queensland Paediatric Cardiac Service neurodevelopmental follow-up programme - CHD LIFE (Long-term Improvement in Functional hEalth). Contextualising best practice recommendations to ensure a family-centred and sustainable approach to understand and support the long-term functional health needs of high-risk children with CHD as standard care was needed. We describe the transition from a centralised pilot Programme to the implementation of an integrated statewide approach aimed at delivering consistent high-level standards of care and a platform to evaluate therapeutic interventions.