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

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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

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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)

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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)

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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)

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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

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When to hospitalise an individual child

• Some individual variation inevitable