Archives of disease in childhood
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Multicenter Study
Pain and behaviour changes in children following surgery.
To quantify postoperative pain and problematic behaviour (PB) in children at home following day-case (same day admission and discharge) or inpatient (≥1 night in hospital) surgery, to identify factors associated with PB at 2 and 4 weeks after discharge and to determine whether pain is associated with PB after adjustment for other factors. ⋯ There was a high incidence of pain and PB persisting for several weeks after surgery in this cohort of children. Previous painful medical experiences and anxiety were important modifiable factors that require further attention from healthcare providers and researchers to potentially improve health and social outcomes for children after surgery.
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Tracheostomy is a common intervention for adults admitted to intensive care; many are performed early and most are percutaneous. Our study aimed to elucidate current practice and indications for children in the UK admitted to paediatric intensive care and undergoing tracheostomy. ⋯ In contrast with current adult UK practice, tracheostomy for children admitted to intensive care is infrequent, performed late following admission and usually surgical. Practice varies significantly. The death rate for children having a tracheostomy performed was not significantly higher than for children admitted to PICU who did not undergo tracheostomy.
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Complex regional pain syndrome type 1 (CRPS-1) is a clinical syndrome that affects one or more extremities and is characterised by persistent pain disproportionate to any inciting event, and at least one sign of autonomic dysfunction in the affected limb(s). The pathogenesis of this syndrome is poorly understood, but its onset is often precipitated by a physical injury, such as minor trauma, fracture, infection or a surgical procedure. ⋯ Here we present a case series of CRPS-1 following immunisation in adolescents, with either diphtheria-tetanus-acellular pertussis (1 case), or human papillomavirus vaccines (4 cases). Enhanced awareness of this syndrome and its potential to occur following immunisation in the paediatric population is vital to the prompt and effective management of this condition.