Prospective community programme versus parent-driven care to prevent respiratory morbidity in children following hospitalisation with severe bronchiolitis or pneumonia.

BACKGROUND: Hospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge. METHODS: This randomised, controlled, single-blind trial enrolled children aged <2 years hospitalised for severe LRTI to 'intervention' or 'control'. Intervention was three monthly community clinics treating wet cough with prolonged antibiotics referring non-responders. All other health issues were addressed, and health resilience behaviours were encouraged, with referrals for housing or smoking concerns. Controls followed the usual pathway of parent-initiated healthcare access. After 24 months, all children were assessed by a paediatrician blinded to randomisation for primary outcomes of wet cough, abnormal examination (crackles or clubbing) or chest X-ray Brasfield score ≤22. FINDINGS: 400 children (203 intervention, 197 control) were enrolled in 2011-2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe. INTERPRETATION: We have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years. TRIAL REGISTRATION NUMBER: ACTRN12610001095055.

Parenting a child with medically diagnosed severe food allergies in New Zealand: the experience of being unsupported in keeping their children healthy and safe.

AIMS: To explore parental experiences of caring for a child with medically diagnosed severe food allergies (MDSFA) in New Zealand. METHOD: This study employed a qualitative methodology, interpretive descriptive analysis, and involved interviews with four parents of children with MDSFA from two different regions in New Zealand. RESULTS: The analysis of the interviews revealed that the experience of parenting a child with MDSFA is an experience of feeling unsupported in the effort to keep the child healthy and safe. Three major themes emerge from this study: the experience of isolation, the burden of accessing resources, and the cost of living with MDSFA. CONCLUSION: The general lack of support experienced by these families from health care professionals is a significant concern both for primary and tertiary health care providers. Multi-disciplinary support is required for these families, and currently there is a lack of health care professionals with the knowledge to support these families. This research highlights that there is a significant need for both workforce development and further research in the area of MDSFA in New Zealand.

Impact of pneumococcal vaccine on hospital admission with lower respiratory infection in children resident in South Auckland, New Zealand.

AIM: To assess the change in admission rates for all Lower Respiratory Infection (LRI) including pneumonia for children resident in Counties Manukau District Health Board (CMDHB) with the introduction of the Pneumococcal Conjugate Vaccine 7 valent (PCV7) in June 2008. METHOD: National Minimum dataset ICD10 coded LRI admissions to any NZ hospital August 2001-July 2011 for children <2 year resident in CMDHB were analysed using Poisson regression, omitting 1 August 2008 to 31 July 2009, the first-year post vaccine introduction. RESULTS: Pneumonia but not bronchiolitis admissions have been declining since 2001. Pneumonia admissions decreased significantly after PCV7 introduction (incidence risk ratio (IRR) (95% CI) 1.51 (1.08-1.77), additional to the gradual decline since 2001. There was significant decline for Pacific children post PCV7 introduction IRR 1.70(1.39, 2.07) but not for Maori children, IRR 1.05 (0.78-1.40). Maori and Pacific children are at increased risk of admission with LRI compared to European children (relative risk (RR) (95%CI) 4.6 (4.3-5.0) and 5.0(3.7-5.3) respectively) as are those living in Decile 9, 10 compared with those from other deciles, RR 1.43 (1.36-1.50). CONCLUSION: The introduction of PCV7 is associated with reduced admissions for pneumonia in young children yet there has been less impact for Maori in CMDHB.

Household characteristics of children under 2 years admitted with lower respiratory tract infection in Counties Manukau, South Auckland.

AIM: To describe household characteristics of admissions for lower respiratory tract infection (LRI) in children aged less than 2 years in Counties Manukau, South Auckland, New Zealand. METHODS: Prospective recruitment of all children aged less than 2 years admitted with a primary diagnosis of LRI from August to December 2007 with caregiver questionnaire. RESULTS: There were 580 admissions involving 465 children, 394 of whom had completed questionnaires (85% response rate). Sixty-four percent of admissions had a diagnosis of bronchiolitis and 26% of pneumonia. Relative risk of admission was 4.4 (95% CI 3.2-6.2) for Maori, 5.8 (4.4-7.9) for Pacific peoples compared with European/others and 3.1 (2.4-3.9) for the most deprived quintile compared with other quintiles. Longer total stay was more likely in those of younger age, who were premature or of Maori or Pacific ethnicity. Household characteristics demonstrate that 25% live with =7 other people, 33% live with 4 or more children, 65% of children are exposed to cigarette smoke and 27% use no form of heating. CONCLUSIONS: Among young children admitted with LRI there is a high rate of exposure to known avoidable risk factors such as smoking, lack of heating and large households in overcrowded conditions.

A comparison of nurses' and parents' or caregivers' perceptions during pediatric burn dressing changes: an exploratory study.

Providing emotional support both to children or young persons and to their parents or caregivers during pediatric burn dressing changes is a crucial aspect of nursing care in a burn unit; however, little research has examined perceptions of the effectiveness of typical interventions. Therefore, the aim of this research was to compare nurses' and parents' or caregivers' perceptions of support interventions provided before, during, and after pediatric burn dressing changes. This research was exploratory in nature and included the development of two differing questionnaires that focused on the perceptions of both parents or caregivers and nursing staff involved in dressing changes. Nurses and parents or caregivers involved in a total of 30 dressing changes completed surveys. Results were then analyzed using Microsoft Excel computer program, and a simple thematic analysis was performed on the responses to the open-ended survey questions. The survey results indicated that participants were generally favorable in their perceptions of the interventions used to support children during dressing changes; however, some gaps in the provision of care were identified. These included the need for clearer communication between the nurse and the parent or caregiver, poor pain assessment skills, and the need for debriefing for those involved in burn dressing procedures. Also highlighted were the difficulties nursing staff had in recognizing distress in parents or caregivers and when this occurred during the process. This research provided insights into coping strategies used by families and nurses and the value of support currently provided by the pediatric burn team. The results indicate that there is a need for improved communication with parents. The presence of a hospital play specialist, in addition to the parent or caregiver, was valuable. Also important was focusing on "comfort" positioning and use of distraction/alternative focus during dressing changes. The information gathered has provided additional strategies that can improve the care offered to children, young people, and families with burn injuries. Such strategies should be implemented in collaboration with the burn multidisciplinary team.