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T H E C A N A D I A N A S S O C I AT I O N O F PA E D I AT R I C H E A LT H C E N T R E S

Hospital at home program eases stress for kids ilary Daum will never forget March 15, 2015. That was the day her son, two and a halfyear old Sage Amor, was diagnosed with a brain tumour. Within two days, Sage was in surgery at Alberta Children’s Hospital with a team of neuro-surgeons who worked to remove the tumour from his delicate brain stem. This was just the beginning of the Amor family’s journey. Daum found out after the surgery that Sage would have to undergo 70 weeks of chemotherapy to shrink part

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of the tumour that was not able to be removed. “It was devastating,� says Daum. “70 weeks is over half his life and I couldn’t imagine what that kind of treatment would do to him,� she says. Now, a pilot program at Alberta Children’s Hosptial has taken some of the stress out of chemotherapy treatments for families like the Amor’s. Hospital at Home is a program where registered nurses (RN) from the oncology program administer chemotherapy and other treatments such

Why Human Milk Matters New study shows expanded EHQHÂżWVIRUSUHPDWXUHEDELHV RQH[FOXVLYHKXPDQPLONGLHW

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utrition is one of the most critical factors in healthy child development from the moment of birth on, but that is especially true for babies born prematurely. For so many preemie parents, the arrival of their baby quickly turns from what was expected to be a blissful time, to a period fraught with a host of unexpected decisions – including those involving their fragile baby’s nutrition. Premature babies will follow a special feeding course, since some of them may be too tiny to eat on their own or require additional nutrition to help them grow.i Human milk is associated with substantial KHDOWK EHQHÀWV IRU DOO LQIDQWV EXW LW LV HVSHFLDOO\ important for premature infants.i Necrotizing Enterocolitis (NEC) is the most common and serious LQWHVWLQDO LQà DPPDWRU\ GLVHDVH DPRQJ SUHPDWXUH babies, which occurs when tissue in the small or large intestines is injured or begins to die off. However, exclusive human-milk nutrition helps decrease the incidence and severity of NEC. An exclusive human-milk diet (EHMD) – when 100 percent of the protein, fat and carbohydrates of the infant’s intake are derived solely from human PLON²LVHVSHFLDOO\EHQHÀFLDOIRUSUHPDWXUHLQIDQWV who require specialized nutrition and care in the Neonatal Intensive Care Unit (NICU). Several studies reported that very premature infants VSHFLÀFDOO\ WKRVH ERUQ ZHLJKLQJ J 

who received an EHMD as opposed to preterm IRUPXOD RU IRUWLĂ€HU PDGH IURP FRZ¡V PLON KDYH D reduced risk of developing medical NEC or surgical NEC.ii, iii, iv “We know that human milk has immune factors, antibodies and high levels of important fats and vitamins, so it makes sense that an EHMD would be a natural source to help them reduce infection and NEC,â€? said Dr. Amy Hair, Assistant Professor of Pediatrics at Baylor College of Medicine and director of the neonatal nutrition program at Texas Children’s Hospital, USA. Breast milk is the best nutrition for all babies, but in the case of extremely premature babies, a mother’s own breast milk does not provide all the nutrients these babies need. Because preemies require additional energy and protein, doctors may decide to DGGDKXPDQPLONIRUWLĂ€HU +0) WREUHDVWPLONIRU the premature infant’s feeding. Parents who have an infant in the NICU should speak with their baby’s neonatologist about the nutritional options for their preemie to ensure they are receiving an exclusive human-milk diet that includes a human milk-based, KXPDQPLONIRUWLĂ€HUIRURSWLPDORXWFRPHVIRUWKHLU infant. No other intervention has been shown to be nearly as effective.iv

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American Academy of Pediatrics. Breastfeeding and the Use of Human Milk. Section on Breastfeeding. >RULJLQDOO\SXEOLVKHGRQOLQH)HEUXDU\@3HGLDWULFVGRLSHGV

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Huston RK, et al. Decreasing Necrotizing Enterocolitis and Gastrointestinal Bleeding in the Neonatal Intensive &DUH8QLW7KH5ROHRI'RQRU+XPDQ0LONDQG([FOXVLYH+XPDQ0LON'LHWLQ,QIDQWVJELUWKZHLJKW ,&$1$GXOW&KLOGDQG$GROHVFHQW1XWULWLRQSXEOLVKHGRQOLQHGRL

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Cristofalo E, et al. Randomized Trial of Exclusive Human Milk versus Preterm Formula Diets in Extremely 3UHPDWXUH,QIDQWV-RXUQDORI3HGLDWULFV  HGRLMMSHGV

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Sullivan S, et al. An Exclusively Human Milk-Based Diet Is Associated with a Lower Rate of Necrotizing (QWHURFRORLWLVWKDQD'LHWRI+XPDQ0LONDQG%RYLQH0LON%DVHG3URGXFWV-RXUQDORI3HGLDWULFV GRLMSHGV

HOSPITAL NEWS AUGUST 2016

Calgary oncology nurse Shelaine Semmens gives Sage Amor, age three, a chemotherapy treatment in the comfort of his own home as mom Hilary Daum holds him close. The service is part of a pilot project called Hospital at Home. as intravenous hydration and antibiotics, and provide education and teaching to parents and families in the comfort of the family’s own home. For busy families like the Amor’s, who are in week 28 of their treatment, the program has meant the world. “This program has had a huge impact on our lives and the ability to lead a more regular life. It’s comforting to have Sage sit on my lap and be surrounded by all his toys while he’s getting treatment,� says Daum.

Hospital at Home is a program where registered nurses (RN) from the oncology program administer chemotherapy and other treatments such as intravenous hydration and antibiotics, and provide education and teaching to parents and families in the comfort of the family’s own home. When the Hospital at Home nurse arrives for an appointment, the process for administering chemotherapy is the same process followed in the hospital. The chemotherapy medication goes through a rigorous checking process within the hospital and is then transported to the family home by the nurse to each appointment. The chemotherapy is then verified again in the home with the nurse and the parent before being given to the patient. The nurse performs a complete physical exam on each patient at each visit, including blood pressure, temperature, oxygen saturation, and heart rate. The patient is then given the chemotherapy through a medication pump into an intravenous line placed into the chest.

The entire process takes approximately 45 minutes, in contrast to the hospital where an appointment can take several hours. Travel time, and the need to find child care for siblings during hospital appointments is eliminated, helping bring back a sense of normalcy to a family’s schedule. “The nurse comes by, he gets his treatment and then we can go to the park,â€? says Daum. “It’s much faster and so much less stressful,â€? she says. Nurses are available to stay after appointments to ensure both the patient and family are comfortable and to address any questions or concerns. Hospital at Home began providing nurse assessments, treatments and supportive care to just a few patients when it began in 2012. Today, the two Hospital at Home nurses visit approximately three patients a day which has added up to over 1,700 home visits to 138 children within the Calgary Zone. Shelaine Semmens, a nurse that’s been with the program since its inception, has seen the impact the program has on families. “Kids and their parents are much more comfortable at home instead of a hospital setting.â€? She adds, “The decrease in stress they experience, the time they save not having to travel, and the normalcy it helps establish in the lives of these people who have had their world turned upside down is invaluable.â€? Daum agrees. “I can’t express the impact this program has had on our entire family, and especially on Sage. Being so young, having the least amount of stress possible by not having to go to the hospital is huge, not only for today, but his future development as well.â€? Patients of the oncology program at Alberta Children’s Hospital who live in Calgary and are interested in having their treatments at home or learning more about the Hospital at Home program can talk to their oncology nurse or physician. Treatment options for patients are decided in conjunction with families and the entire care team and based on the needs of each H individual patient. â–

www.hospitalnews.com

Hospital News 2016 August Edition  

Focus: Pediatrics, Ambulatory Care, Neurology, and Hospital-based Social Work. Special CAPHC Paediatric Supplement.

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