title: Specialist pediatric dialysis nursing improves outcomes in children on chronic peritoneal dialysis.
abstract: Chronic peritoneal dialysis (PD) for children in Singapore was instituted in 1988 at the National University Hospital with adult nurses providing dialysis services during the first 10 years. In 1998, a specialist pediatric dialysis nursing team was recruited. This study was conducted to determine the impact of dialysis nursing service on PD-related outcomes during the two nursing periods. Comparing the adult (group 1) and pediatric (group 2) nursing periods, the peritonitis rate was significantly higher in group 1 (RR 1.90; 95%CI 1.27-2.84), and this association did not weaken after adjusting for age, gender, and exit site infections. Exit site infection rate (RR 2.16; 95%CI 1.44-3.23), risk of peritonitis during the first year (RR 3.65; 95%CI 1.68-7.90), and multiple peritonitis attacks (RR 2.45; 95%CI 1.32-4.55) were higher in group 1. The peritonitis rates for adult patients cared for by the same adult nurses declined sharply from 1.05 episodes per patient-year between 1989 and 1992 to 0.41 episodes per patient-year between 1995 and 1997, however the corresponding pediatric rates did not change (1.48 to 1.06 episodes per patient-year, respectively) until the second era when specialized pediatric nurses were available. In conclusion, establishment of a specialist pediatric dialysis nursing team resulted in significant improvement in infection-related PD outcomes.
authors.affiliation: Shaw-NKF Children's Kidney Centre, University Children's Medical Institute, National University Health System, Singapore, Singapore.
authors.forename: W D Vindya N
authors.initials: WD
authors.lastname: Gunasekara
authors.forename: Kar-Hui
authors.initials: KH
authors.lastname: Ng
authors.forename: Yiong-Huak
authors.initials: YH
authors.lastname: Chan
authors.forename: Eric
authors.initials: E
authors.lastname: Aragon
authors.forename: Pei-Pei
authors.initials: PP
authors.lastname: Foong
authors.forename: Yew-Weng
authors.initials: YW
authors.lastname: Lau
authors.forename: Lee-Kean
authors.initials: LK
authors.lastname: Lim
authors.forename: Chien-Wyei
authors.initials: CW
authors.lastname: Liew
authors.forename: Wee-Song
authors.initials: WS
authors.lastname: Yeo
authors.forename: Hui-Kim
authors.initials: HK
authors.lastname: Yap
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010371:Pediatric Nursing / Q000706:statistics & numerical data*; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000451:nursing*; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome