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The role of hospital

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Head, Dept of Paediatrics, ASH. The role of hospitalising a child with malnutrition ... Head, Dept of Paediatrics, ASH. Photo: Liz Mowatt. 15 mins. Hospitals 101 ... – PowerPoint PPT presentation

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Title: The role of hospital


1
The role of hospital
  • Rob Roseby
  • Respiratory and General Paediatrician
  • Senior Lecturer, Flinders University
  • Head, Dept of Paediatrics, ASH

2
The role of hospitalising a child with
malnutrition
  • Rob Roseby
  • Respiratory and General Paediatrician
  • Senior Lecturer, Flinders University
  • Head, Dept of Paediatrics, ASH

3
Photo Liz Mowatt
4
  • 15 mins
  • Hospitals 101
  • Role of doctor wrt CM/ FTT
  • Role of inpatient stay

5
Hospitalising a child 101
  • 2 reasons only
  • Failure to respond to adequate outpt mx
  • Delivery of healthcare which cant be delivered
    in another setting

6
Hospitalising a child 101 (2)
  • A childs place is at home with family
  • Hospitals are dangerous
  • Hospitals are expensive

7
Hospitalising a child 101 (3)
  • Hospitals are full of
  • Terrific health professionals across disciplines
    with access to information
  • Beds
  • Drugs, fluids and other goodies

8
Hospitalising a child 101 (4)
  • Conflict!
  • Beneficence
  • Non-Maleficence
  • Justice
  • Autonomy

9
Role of doctor re CM/FTT
  • Assessment of a diagnostic problem

10
Medical assessment of anthropometry
  • Weight, height/ length, Head circumference
  • Growth trajectory

11
Medical assessment of cause
  • Inadequate intake, eg
  • Milk supply issue
  • Incorrect milk powder
  • Food deficiency
  • Anatomical or neurological problem
  • etc
  • Excessive losses, eg
  • Chronic Diarrhoea
  • Vomiting
  • Pancreatic disease
  • Malabsorption syndromes
  • Giardia, coeliac dis.
  • etc
  • Increased energy requirement, eg
  • Most Chronic Diseases
  • UTI
  • Chronic chest disease
  • etc
  • Cant grow, eg
  • Genetic/ chromosomal abn
  • FASD other syndromes
  • Endocrine/ metabolic d/o

12
Medical assessment of effect
  • Complications

13
Role of inpatient stay
  • Assessment of the above is easier as an inpt-
  • access to mother/ carer, child, observers,
    specimen collection and transport, tests and
    results

14
Role of hospitalisation for CM
  • Advantages
  • Assessment
  • Nutritional rehab, multidisciplinary team
  • Discharge and follow up plans
  • (Schwartz 2000)
  • Disadvantages
  • Separation from home, family
  • Stressful environment
  • Staffing pressures
  • Nosocomial infection
  • (Oates 2001)

15
Role of hospitalisation for CM (2)
  • Influences
  • Constraints on health system-gt decisions re
    competing priorities
  • Primary prevention vs Secondary prevention vs
    Tertiary care
  • (Black 1999, Brewster 2008)
  • Access to community based services, incl skill of
    staff distance perceived level of compliance
  • (Lee 2003)

16
Role of hospitalisation for CM (3)
  • Outcome?
  • Limited evidence
  • ASH study 2002 of hospitalision for FTT
  • effective in re-establishing weight gain
  • effective in identifying organic contributors to
    malnutrition, but
  • 38 hospital acquired infection
  • 53 readmitted within 6 months
  • Children did not sustain catch-up growth
  • (Russell et al, 2004)

17
When to hospitalise children for CM
  • Little disagreement
  • severe wasting
  • dehydration and/or infection or other
    intercurrent illness
  • when community-based interventions have failed
  • where there are other serious risk factors (incl.
    psychosocial) for the child and family
  • assessment
  • identification and treatment of organic factors
  • nutritional rehabilitation
  • (Russell 2004 , Brewster 2008)
  • Discharge plan and follow up
  • Policy development has been difficult but is
    progressing

18
When to hospitalise an individual child
  • Some individual variation inevitable
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