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Improving the management of children (especially Indigenous children) hospitalised with bronchiolitis

McCallum, Gabrielle Britt (2014). Improving the management of children (especially Indigenous children) hospitalised with bronchiolitis. PhD Thesis, Charles Darwin University.

Document type: Thesis
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Author McCallum, Gabrielle Britt
Title Improving the management of children (especially Indigenous children) hospitalised with bronchiolitis
Institution Charles Darwin University
Publication Date 2014-12
Thesis Type PhD
Supervisor Chang, Anne
Morris, Peter
Petsky, Helen
Abstract Bronchiolitis, a typically self-limiting illness causes significant morbidity and remains a leading cause of hospitalisation among infants globally. In some populations such as Northern Territory Indigenous infants, bronchiolitis is more severe and the incidence is higher. Despite being the most common acute lower respiratory infection worldwide, the current mainstay of treatment for hospitalised bronchiolitis is supportive.

This thesis presents findings of studies undertaken to improve the management of hospitalised bronchiolitis, with a particular focus on Indigenous children. The major hypothesis of my thesis was that azithromycin improves short and long term clinical outcomes of children hospitalised with bronchiolitis. Gaps in knowledge were addressed and the principal findings were:

1. Severity scoring systems are easy to use, reliable and repeatable and can be used with health staff of varying levels of experience.

2. Different doses of azithromycin (single or 3-weekly doses) did not improve short or long term clinical outcomes and should not be routinely used to treat children hospitalised with bronchiolitis.

3. Azithromycin reduced the proportion of bacterial carriage, but had no impact on viruses or atypical bacteria.

4. Non-traditional risk factors prolonged hospitalisation. Presence of persistent symptoms 3-weeks beyond hospitalisation increased the risk for ongoing morbidity, respiratory readmissions and developing bronchiectasis.

5. Mobile phones in conjunction with a culturally sensitive framework were an effective strategy to improve adherence and retention of participants in the largest randomised controlled trial.

6. Improved clinical care for chronic cough post-bronchiolitis is needed for Indigenous children, in view of the high rates of persistent symptoms and poorer long-term respiratory outcomes.

The long term consequence of respiratory disease among Indigenous children is an important public health issue. Identifying target points that can lead to optomising clinical care and better lung health and prevention of subsequent bronchiectasis among Indigenous children are needed.
Additional Notes Please note that some articles in the thesis is available in hard copy only.

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