Biliary atresia is a rare condition in newborn children in which the common bile duct between the liver and the small intestine is blocked or absent. If unrecognised, the condition leads to liver failure but not (as one might think) to kernicterus. It has no known cause, and the only effective treatment is by surgery.

Symptoms and diagnosis

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Initially, the symptoms are indistinguishable from neonatal jaundice, a common phenomenon. Prolonged jaundice that is resistant to phototherapy and/or exchange transfusions should prompt a search for secondary causes. By this time, liver enzymes are generally measured, and these tend to be grossly deranged, hyperbilirubinaemia is conjugated and therefore does not lead to kernicterus. Ultrasound investigation or other forms of imaging can confirm the diagnosis.

Biliary atresia is a rare disorder. About one in 15,000 to 20,000 babies do not have complete bile ducts. There is no known genetic link. Biliary atresia seems to affect girls more than boys. Within the same family, it is common for only one child in a pair of twins or only one child within the same family to have it. Asians and African-Americans are affected more frequently than Caucasians. There does not appear to be any link to medications taken during pregnancy.

More on [ Biliary atresia ]

Journal of Child Health Care current issue

Children's Nursing Education: Members club or street party?
Randall, D., McTaggart, I. Wed, 20 May 2009 00:00:00 -0000

Creating space: hospital bedside displays as facilitators of communication between children and nurses
Lewis, P., Kerridge, I., Jorden, C. F.C. Wed, 20 May 2009 00:00:00 -0000
Over the past decades there has been a marked change in the physical environment of children's hospitals and the configuration of individual bed spaces. No longer the stark, clinical spaces typical of years gone by, the modern hospital bed space hosts a variety of visual displays reflecting different aspects of the child's life. Building upon ideas introduced by Lewis and informed by a recent qualitative study into hospital bedside displays, this article discusses the role that displays can play in developing, deepening and enriching relationships between nurses, patients and their families in the paediatric hospital environment. It discusses the links between hospital and home, the specific function of the display of photographs and the nurse's role in `knowing' the patient and facilitating links between hospital and home. It concludes that nurses' conscious observations of a visually rich environment may make a positive contribution to the care that they deliver for the benefit of their patients and themselves.
Influences on nurses' scoring of children's post-operative pain
Simons, J., Moseley, L. Wed, 20 May 2009 00:00:00 -0000
There is a lack of clarity as to why some nurses are not delivering optimal pain management to children post-operatively. This retrospective chart review study examined nurses' pain scoring on 175 children during the first 24 hours post-operatively. Data were analysed on the amount of assessments made, assessment scores recorded, as well as the age, gender and type of surgery performed. One-quarter of children had no assessment record of their pain in the first 24 hours post-operatively. When the pain tool was part of an observation chart, nurses recorded more pain scores. Nurses' scoring of children's pain is influenced positively by children under five years of age and those who undergo abdominal surgery. Nurses who had access to one document for recording vital signs as well as pain scores were more likely to assess and record a child's pain score than nurses who had to use a separate chart.

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