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PubMed1987

How should chylothorax be managed?

The management and complications of chylothorax occurring beyond the neonatal period were reviewed retrospectively. Records from 15 patients treated between 1976 and 1986 were analysed; a combination of thoracocentesis, chest drain insertion, and dietary modification were successful in abolishing chyle leakage in 10 cases. One child died from complications of cardiac surgery rather than from the chylothorax, and surgical intervention was necessary in the remaining four patients and included pleurectomy in three and thoracic duct ligation in the fourth. Lymphopenia, hypoalbuminaemia, hyponatraemia, and weight loss were the most common complications of conservative management and tended to occur in those patients with the longest duration of drainage. Postoperative recovery after pleurectomy and thoracic duct ligation was uneventful. We conclude that conservative management of chylothorax will be successful in most cases. Complications of such a policy are fairly common but rarely serious.

Child↗

PubMed1987

The nutrition team in a children's hospital.

This paper discusses the reasons for a paediatric nutritional care team, the members involved, and their role within the team. The methods used for nutritional assessment are described and the cost effectiveness of the nutrition team's involvement is discussed.

Child↗

PubMedDate not supplied

Psychological preparation for nasogastric feeding in children.

Psychological preparation of children undergoing enteral nutrition by nasogastric tube was evaluated in a prospective study of 48 children nursed at home. They were randomly allocated to receive either standard informal preparation or detailed psychological preparation and support. The children were divided into two groups according to age: group A comprised toddlers and younger children aged 2-6 years and group B comprised older children and adolescents aged 7-16 years. Detailed questionnaires were administered to all parents and older children by dietetic colleagues who were blinded to the type of preparation received by the children. The results emphasize that detailed psychological preparation of families takes time. Passage of a nasogastric tube was seen as very distressing to both parents and children. Having a nasogastric tube was perceived as a major problem by group A. There was no statistical difference in the effects of enteral nutrition between younger children who received routine preparation and those who received detailed preparation; however, parental assessment of their child's behaviour was the sole means of determining how the younger child felt and reacted. In group B, there were marked differences: scores suggested that those who received detailed preparation had been better prepared for enteral feeding in hospital and at home and that the passage of the nasogastric tube, although unpleasant, was less distressing to them (P < 0.05). Talking to a nurse and play therapist was seen by parents as essential (P < 0.05). The authors conclude that children should be prepared for painful procedures and followed up sensitively, according to their needs.

Adaptation, Psychological↗