Diploma of Child Health
Feasibility of using a Neonatal Early Warning System in Neonates, in Port Moresby General Hospital Special Care Nursery.
Dr Roy Iga Neonatal Early Warning Systems DCH 2022
Introduction
Worldwide there are about 2.4 million babies that die before the 28 days of life. In Papua New Guinea, case fatality rate for neonates is 5.9% in 2021. As part of improving, quality care for neonates, recommendations were made to use color coded observational charts to assist in providing care for sick children. Even though, In Papua New Guinea there is a color-coded chart formulated and used for children, there are none specifically tailored for neonates.
This study seeks to investigate the feasibility of using a Neonatal Early Warning System (NEWS) to identify neonates at risk and to promptly escalate care.
Method
An observational study was conducted to find out if a NEWS can be used to identify neonates at risk by using current vital observation techniques of nurses in PMGH, SCN. A color-coded observation chart was adapted from the Plymouth Hospital Neonatal Early Warning System chart, and used to collect data over an 8-week period (01 May 2022 to 30 June 2022). 157 patients were recruited in the study and followed up in the first 72 hours of life. Neonates were grouped into two groups, those that have triggers (had vitals that fell in the red zone) and stable group (had vitals that did not fall in the red zone).
Results
Of the 157 patients recruited 45.86% (n=72) were stable, and 54.14% (n=85) had triggers, that prompt a response. In the group that had triggers 55.29% (n=55) had appropriate interventions done, whilst 44.71% (n=38) did not have the appropriate intervention. It was also found that neonates that had fall in the red zone (triggers) were more likely to die in the first 72 hours of life as compared to neonates who did not have triggers.
Conclusion
NEWS is a tool that can be used to identify neonates at risk for unfavorable outcomes, however there has to be proper training of its use and knowledge of escalation of care, before implementing it in SCN.
A qualitative study on the need for age-appropriate adolescent health care in Alotau Provincial Hospital
Dr Leilani Suwari Adolescent health needs in Milne Bay Province DCH 2022
Introduction
The adolescent population makes up 22.7% of the total population of Papua New Guinea (PNG). The lack of appropriate health and social services for adolescents in PNG, results in their marginalization. The care of sick adolescents admitted to hospitals in Papua New Guinea should be shared between the paediatric and adult medical units. The current cut-off age for admission to a paediatric ward is 12 years old while the adult wards admit 18 years and above. The management of chronic cases such as congenital or acquired heart problems, epilepsy, cerebral palsy, and multiple congenital abnormalities in this age gap is also an issue. There is currently no allocated ward space and appropriate facilities for sick adolescents in hospitals within PNG. Alotau Provincial Hospital, is no exception to this fact. Hospitals in PNG should support appropriate clinical care of sick adolescents by the introduction of an adolescent unit. This study aims to explore the perceptions of adolescents towards the quality of health care received, in Alotau Provincial Hospital.
Methodology
A qualitative-observational study was carried out from 26/04/22 – 11/08/22, amongst all adolescents (persons aged 10 – 19 years) admitted to a ward, or receiving out-patient care in Alotau Provincial Hospital, i.e. Paediatric Ward, Paediatric Consultation Clinic, Paediatric TB Clinic, Internal Medicine Ward, Surgical Ward, Obstetrics & Gynaecology Ward, and Antenatal Clinic. Data was collected via semi-structured interviews with participants of the study; and contextual data, obtained from their medical charts. Data analysis was done using the method of Thematic data analysis. Informed verbal consent was obtained from each participant and guardian – of children < 18 years of age; at the beginning of the interviews.
Results
A total of 57 adolescents were interviewed, 32 adolescents had a negative first impression of the hospital; whilst 25 of them felt the opposite way. 46 adolescents preferred an adolescent-friendly setting, as opposed to their current setting (n = 11); stating that it would allow for positive peer-interaction (n=14), improve their experience in the hospital (n=33), and improve the quality of health care received (n=2).
Conclusion
This study shows that adolescents are able to perceive the need for adolescent-friendly health services and advocate for improvement in the quality of health care received
Master of Medicine
Re-presentation of neonatal sepsis to the children’s ward in Port Moresby General Hospital
Dr Venao Seta Neonatal Sepsis in PMGH MMed 2022
Introduction
This study investigated the incidence of admissions of neonatal sepsis to the wards and further expanded on trying to identify what the common reasons of these presentations were. The study was conducted from November 2021 to April 2022. It was instigated by an observation where there was a rise in admissions of neonates following delivery at the PMGH. This study aimed to find the incidence of NNS admissions to the wards in PMGH. 2) To identify main admitting diagnosis of NNS.
Methods
Full admissions and consents were done for any neonate admitted via the Childrens’ Emergency Department. Data was collected using a data collection form that attained information on antenatal and delivery history; details of care at home; reason for current presentation and findings of examinations that may suggest sources of infection. Patient outcomes (discharge/died) were included.
Results
A total of 132 children were recruited to this study. 3 died (CFR 2.2%) whilst the rest recovered and discharged (n=129). The incidence in this study was about 2%. The main reasons for admissions to the wards were due to pneumonia (69), skin sepsis (28), cord sepsis (15), presumed sepsis (14) and abscesses (3). We saw more children with late onset sepsis (n=108) Most of the mothers were booked and were delivered at PMGH (n=120).
Conclusions
The incidence rate of 2% may not be entirely reflective of the true picture of NNS within the hospital due to the small sample size. Pneumonia was still a leading cause of admission in this study. This is also true for admissions in the older paediatric population as indicated in the Child Health Mortality report for 2021. Most of these presentations were of late onset sepsis; this finding reflects conditions and care of the newborn at home. A visit to individual households would have added more value to this study. We recommend the following: 1) A similar study be done nation-wide with more emphasis on risk factors of neonatal sepsis at the household and community level. This would provide a preventative approach to reducing neonatal sepsis at household and community levels thus reducing late onset sepsis to a certain degree. 2) There should be more emphasis for staff to advocate on KMC and essential early newborn care as in this study we identified that only 3% (n=4) out of the 132 recruited were told about and practised KMC.
Survey of paediatric palliative care at Port Moresby General Hospital
Dr Villa Watch Paediatric Palliative Care MMed 2022
Paediatric palliative care as defined by the World Health Organization involves the child’s body, mind, and spirit, but also involves supporting the family. Palliative Care starts from diagnosis and continues whether child is receiving curative treatment or not. As clinicians, identifying and relieving the child’s physical, psychosocial, and spiritual distress is imperative. This study aims to identify the characteristics of children admitted to the Paediatric Ward of the Port Moresby General Hospital with palliative care needs and how parents and health care workers view the palliative care services provided to these children. Data will be collected from the child’s admission chart and will be analysed using frequency and percentages while in-depth interviews will be carried out on parents and health care workers using semi-structured questionnaires which will be analysed using thematic analysis. The results will be useful in improving palliative care for children admitted with life-threatening and life-limiting illnesses in our setting.
A cohort of children with HIV in Papua New Guinea during an era of anti-retroviral transition.
Dr Gordon Pukai HIV and ART in children MMed 2022
Introduction
2019-2021 was an era of transition of anti-retroviral therapy from non-nucleoside reverse transcriptase inhibitor (NNRTI) based therapy to the new dolutegravir (DTG) based treatment. This study was conducted to observe the difference in the clinical and virological outcomes in the children with the new DTG and Lopinavir-ritonavir (LPVr) regimes as compared to their previous NNRTI-based ART regimens at Port Moresby General Hospital.
Methods
The participants were 60 children living with HIV who were followed at the Well Baby Clinic at PMGH. A survey form was filled included infants and children less than 18 years old.
Results
At enrollment in the study, 25 children had moderate malnutrition; 27 children had severe malnutrition; only 8 were well nourished. Fifty-three of the 60 were on an NNRTI based regimen. 2 were on a triple-NRTI based regimen, and 5 were on a lopinavir-ritonavir based regimen. 52 children underwent viral load testing and 37 had viral load levels >1000 copies per ml. Only 15 had adequate viral suppression with viral load <1000 copies per ml. Thirty-nine children out of 60 had clinical failure as defined by WHO. Of the 37 who had viral load >1000, all had evidence of clinical failure.
Of the 54 children tested post change to the new ART regimen, 49 (90.7%) had viral load levels <1000. 5 had viral load >1000. 41 children had a reduction in their viral load after changing treatment, 1 had an increase, and in 5 the viral load was unchanged.
Conclusion
The DTG- based regimen provides adequate reconstitution of immunity, an effective reduction in the viral load and good clinical improvement.
The outcome of low birth weight babies in Vanuatu
Dr Annette Garai Low birth weight babies in Vanuatu MMed 2022
Background
Low birth babies (LBW) are a fragile cohort. Medical technology has increased survival of these babies. In Vanuatu, improving their outcomes and survival is a significant health challenge. The objective of this study was to prospectively document the outcomes of LBW babies admitted to Special Care Nursery (SCN). Recording the mother’s experiences of caring for a LBW baby was a secondary objective.
Methods
This is a prospective descriptive cohort study compromising of 49 recruits weighing less than 2.5kg from April to August 2019. Patients were followed up at six and twelve months post discharge and their outcomes recorded. A qualitative study was conducted to identify experiences and challenges the mothers faced in caring for a LBW baby.
Results
Thirty-nine babies followed up. Thirty-four patients gained good weight in their first six months of life. At 12 months post discharge, 19 babies had pallor, 17 had normal head ultrasound scan, and 1 baby had retinal detachment. Most babies achieved their developmental milestones by 12 months. Mothers identified stress as a common risk factor for their premature delivery.
Conclusions
This study outlined the outcomes of LBW babies in Vanuatu and highlighted issues of concerns by their mothers. It is vital that all LBW babies are followed up well after discharge from SCN. Equally important is the support for mothers of LBW babies to achieve better outcomes.
Procedural sedation for paediatric CT scans
Dr Benji Daur Sedation for CT scans in children MMed 2022
Introduction
Computerized Topography (CT) scans have been an important diagnostic tool since its introduction in the 1970s. The success of Paediatric CT scans are complicated by anxious uncooperative children and the administration of sedation has proven beneficial in improving success of completing the procedure. The primary aim of this study is to evaluate the safety and effectiveness of procedural sedation protocols provided by paediatric clinicians who are not trained anaesthetists for Paediatric CT scans in Port Moresby General Hospital (PMGH). Secondary aims include identifying complications and factors that could influence success of oral chloral hydrate and intravenous diazepam.
Methods
A prospective observational analysis of procedural sedations for CT scans between September 2020 to June 2021. Port Moresby General Hospital CT scan room.
Results
99 sedation events were included in this cohort. 49 patients received oral chloral hydrate and 50 received intravenous diazepam prior to the procedure. 11 failed sedations occurred most noticeable from the diazepam group (Fisher’s exact p=0.008). Complications included vomiting (3) and over-sedation (4) in the chloral hydrate group. Significant factors that influence success include the drug used and ASA of patient prior to study.
Conclusions
This study has proven that paediatric clinical staff can provide safe and effective procedural sedation for children who require CT scans in hospital with oral chloral hydrate and intravenous diazepam.
Children and adolescents admitted with Covid-19 infection at the Port Moresby General Hospital
Dr Justin Kali Covid-19 in children and adolescents MMed 2022
Introduction
COVID-19 is a global pandemic which has infected and killed millions of people throughout the world. Healthcare systems have faced are lot of challenges in fighting this disease and scientists are conducting studies to investigate this killer disease. Numerous case reports and studies have been done on the clinical characteristics, outcomes, and treatment of COVID-19 however the studies done in children are limited. There is no study on COVID-19 in children in Papua New Guinea. The aim of this study is to describe the clinical characteristics and outcomes of children and adolescents admitted with a positive test of COVID-19 at the Port Moresby General Hospital.
Method
This study is a retrospective descriptive study of children and adolescence admitted to the Port Moresby General Hospital who has tested positive for Covid-19 over a period of 6 months. The study mainly looked at their clinical characteristics and outcomes. Data was extracted from (1) PMGH laboratory COVID-19 data and (2) Admission charts according to a modified form derived from case information forms (CIF).
Results
Sixty patients tested positive for COVID-19 during the 6 months and were sick enough to be admitted to the paediatric isolation wards. The median age was 17 months. The most common symptoms were fever in 53 (18.5%), cough 47(16.4%), poor feeding 44 (15.3%) and dyspnoea 39 (13.6%). The most common clinical signs on examination were chest indrawing 35 (44.9%), nasal flaring/grunting 19 (24.4%) and pallor 15 (19.2%). Five (6.4%) had reduced level of consciousness and 2 (2.6%) had signs of shock. Clinical diagnosis saw nearly half of the patients admitted for COVID-19 pneumonia alone 28 (46.7%) and the other 33 (55.2%) was COVID-19 with other diagnosis. Twenty-eight (46.7%) of the COVID-19 patients had comorbidities. Most COVID-19 cases were mild 45 (75.0%) and 5 (8.3%) had severe COVID-19. 50 (83.3%) patients received empirical antibiotics and systemic corticosteroids. Eleven patients died (case fatality rate 18.3%), 4 (6.7%) absconded and 4 (6.7%) left hospital at their own risk. Of the 11 children that died, all had COVID-19 pneumonia, 1 (1.7%) also had multisystem inflammatory syndrome and 3 children (5.1%) had significant comorbidities that contributed to their deaths.
Conclusions
The clinical characteristics of children infected with COVID-19 were similar to other studies done in other countries. Most of the COVID-19 cases were mild. Children with comorbidities infected with COVID-19 have increased risk of mortality.