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The purpose of this paper is to implement Six Sigma approach to decrease the length of stay (LOS) of neonatal jaundice patients in an Indian government rural hospital situated in northern hill region.

Six Sigma’s Define–Measure–Analyse–Improve–Control procedure is applied in order to decrease the LOS of neonatal jaundice patients. The mean and standard deviation have been computed as 34.53 and 20.01 h, respectively. The cause and effect diagram is used in the “Analyse” phase of the Six Sigma. The regression analysis and GEMBA observation techniques are used to validate the causes identified through cause and effect diagram.

The waiting time for registration, waiting time for tests, waiting time for phototherapy and time for discharge implementation are the main factors that are responsible for longer LOS. Based on the identified root causes, some recommendations are suggested to the hospital administration and staff members in order to reduce the LOS.

The present research is limited to provide recommendations to the hospital administration to reduce LOS and it entirely depends upon the implementation of the administration. However, target of administration is to reduce the LOS up to 24 h.

Six Sigma model will reduce bottlenecks in LOS and enhance service quality of hospital. The developed regression model will help the doctors and staff members to assess and control the LOS by controlling and minimising the independent variables.

The project will directly provide benefits to society, as LOS will decrease and patients’ satisfaction will automatically increase.

Six Sigma is a developed methodology, but its application in paediatric department is very limited. This is the first ever study of applying Six Sigma for neonatal jaundice patients in India.

Several audits of clinical practice have confirmed that there is insignificant yield from screening of prolonged jaundice babies with a wide range of tests including thyroid function test (TFT) and full blood count (FBC). This paper aims to audit local practice based on a newly adopted rationalised protocol of selective screening with split bilirubin supplemented with other investigations based on clinical risk assessment.

The paper uses a retrospective audit of 50 babies referred for prolonged jaundice to a large district hospital in South West England. The authors also designed an easy‐to‐use, user‐friendly software application as a quick aid for implementation of the prolonged jaundice protocol.

The overall annual incidence of prolonged jaundice was 2.2 per cent of all live births. 32 patients (64 per cent) had only split biliburin test according to the protocol. In total 16 patients (32 per cent) had 18 tests requested unnecessarily including seven liver function test (LFT), eight FBC, one each of glucose, TFT and serum electrolytes. No patient with any serious liver disease was missed.

Appropriate recommendations for optimising the implementation of the current protocol based on the available scientific evidence were introduced.

After two years of implementation of the protocol, it has been found to be cost‐effective and safe. The electronic software provides a useful prompt in guiding the investigation of prolonged jaundice.

The purpose of this paper is to assess available human resources for neonatal care and their skills, in order to explore health providers’ perceptions of quality of neonatal care in health facilities in Ghana.

Data were gathered using qualitative interviews with health providers working in the maternity and paediatric wards and midwives; direct observation; and documentary review at a regional hospital, a municipal hospital and four health centres in a municipality in a region in Southern Ghana. Data were analysed using thematic framework through the process of coding in six phases to create and establish meaningful patterns.

The study revealed that health providers were concerned about the number of staff available, their competence and also equipment available for them to work more efficiently. Some essential equipment for neonatal care was either not available or was non-functional where it was available, while aseptic procedures were not adhered to. Moreover, personal protective equipment such as facemask, caps, aprons were not used except in the labour wards where staff had to change their footwear before entering.

Limited number of health providers and facilities used, lack of exploration of parents of neonates’ perspective of quality of neonatal care in this study and other settings, including the teaching hospitals. The authors did not examine issues related to the ineffective use of IV cannulation for neonates by nurses as well as referral of neonates. Additionally, the authors did not explore the perspectives of management of the municipal and regional health directorates or policy makers of the Ministry of Health and Ghana Health Service regarding the shortage of staff, inadequate provision of medical equipment and infrastructure.

This paper suggests the need for policy makers to redirect their attention to the issues that would improve the quality of neonatal health care in health facilities in Ghana and in countries with similar challenges.

The study found that the majority of nursing staff catering for sick newborns were not trained in neonatal nursing. Babies were found sleeping in separate cots but were mixed with older children. The study suggests that babies should be provided with a separate room and not mixed with older babies.

There seemed to be no defined policy framework for management of neonatal care in the country’s health care facilities. The study recommends the adoption of paediatric and neonatal care nursing as a specialty in the curricula of health training institutions. In-service trainings should encompass issues related to management of sick babies, care of preterm babies, neonatal resuscitation and intravenouscannulation, among others.

Speeding technology to market, and to the right market, is increasingly held out as the hallmark of well run technology‐based organisations. This paper details an inexpensive methodology to evaluate the economic viability of technologies that have potential applicability in a broad range of market segments.

The purpose of this paper is to measure the craniofacial dimensions of 41 full‐term neonates nursed in the Special Care Baby Unit of Queen Mary Hospital in Hong Kong, so as to develop a good‐fitting and secure eye‐patch protector for protecting neonatal eyes from the strong light in phototherapy.

In total, 14 craniofacial dimensions were measured using a new, safe and non‐intrusive method with a close‐range photogrammetric system and two dimensions of head circumference and facial arc were measured using manual method with a disposable paper tape in the hospital environment. Birth information of gestation, age, gender, present weight and present length has been recorded. A descriptive statistics was produced based on the measured data. Correlations between each pair of dimensions were investigated and factor analysis was conducted for application on an eye‐patch protector development.

Head circumference was identified as the most desirable key dimension of a sizing system for an eye‐patch protector. Two head circumferences with the sizes of 310‐349 mm and 350‐389 mm, respectively, could effectively cover all full‐term neonates. Design guidelines were generated according to the measurement of the craniofacial dimensions.

This paper presents the craniofacial dimensions of head, eye, nose and ear parts of full‐term neonates.

Cambodia has one of the highest death rates for children under five years of age in Southeast Asia. The high mortality rate of children under five years of age, especially the neonate is 35 per 1,000 for the period zero to four years. There are no neonatal nursing standards of practice to guide nurses providing neonatal nursing care. Some general guidelines are currently being implemented for both doctors and nurses. The Minister for Health officially launched the Cambodian Council of Nurses’ Guideline for the Standard of Nursing Care in December 2015. In the absence of specific neonatal nursing standards of practice, the purpose of this paper is to develop the Neonatal Nursing Standard of Practice for Cambodia.

The Delphi technique was selected as being appropriate for this study. The snowball with purposive sampling was used. The identified experts were located across Cambodia so the e-Delphi approach was considered appropriate and applicable according to the study context. Four experts preferred to be interviewed face-to-face, while 16 experts were confident to use e-mail to respond to the questionnaire in Round 1. In total, 19 experts provided responses via e-mail to the Rounds 2 and 3 questionnaires.

A Standard for Neonatal Nursing Practice for Cambodia which consists of ten standards was found as a result of this study: assessment, nursing diagnosis, planning, implementation, evaluation, ethics, evidence-based practice and research, health teaching and health promotion, continuing education, and communication.

All items and sub-items achieved consensus as either being at the most significant level and therefore, could be key indicators for neonatal nursing standards of practice. The results of this study can be incorporated into a focused discussion led by the Nursing and Midwifery Bureau of the Ministry of Health to develop national standards of practice for neonatal nurses in Cambodia.

The purpose of this paper is to identify the reasons for discharges against medical advice (DAMA) and the possible outcomes among pediatric patients.

A retrospective cohort study was conducted on all children admitted and then discharged against medical advice in two maternity and children’s hospitals in Jeddah, 2014. Phone interviews were conducted, and medical records were reviewed for DAMA and control groups; a semi-structured questionnaire was used to collect this information.

The top three reasons identified for DAMA were parent’s false assumption that their child’s condition had improved (43.8 percent), dissatisfaction with treating/managing team (16.2 percent) and difficulties arranging care for patient’s siblings at home (7.7 percent). The readmission rate was significantly higher among DAMA pediatric patients compared to the control group (28.5 percent vs 11.5 percent) at 30-day follow-up, which highlights the importance for developing interventions aimed at reducing DAMA.

This study helps us to better understand DAMA reasons and outcomes. Understanding these factors can encourage appropriate interventions and policies for reducing DAMA rates. In this way, pediatric patients can be protected from inappropriate discharge consequences.

This article is based on a case study jointly presented by Lyndy‐Lee Green, Brain Injury Case Manager and Jo Dicks, Children's Social Worker, describing their experiences of joint working on a case of a young man who sustained a brain injury at birth. It aims to describe a model of successful collaborative delivery of a personalised service, and to demonstrate what can help or hinder professional relationships and client outcomes.

A joint perspective on a three year period of collaborative work with one client was obtained from a case manager in private practice and a social worker in statutory services, with reference made to the current legislative context in health and social care. The findings were discussed with reference to: implementation of the personalised agenda; guidance and practice methods used by case managers in private practice; and understanding of the difficulties caused by brain injury in young people.

The availability of statutory services was found to be insufficient in comparison with the collaborative input received by one young man with a brain injury, utilising available statutory services, and supplemented by private funding aiming to maximise quality of life. The paper identified a number of elements that contribute to effective joint working: communication and the value of face to face meetings; maintaining the client's goals and needs at the centre of all decision making; joint responsibility and positive risk taking; understanding and valuing roles; rapid response to crisis situations and contingency planning; the need for planned and coordinated transition; knowledge of brain injury; autonomous decision making, supported at organisational level; and creativity.

There is little evidence examining the issues that arise at the convergence of private case management and statutory service provision, particularly where funding for services is not the primary concern. This case study highlights the collaborative practice that can be achieved working across the boundaries of statutory services and private practice and provides an insight into the complexity of the needs of young people with brain injury in the community. This article will be of interest to practising case managers, and to social work care managers.

In absence of breast milk, humanized mammalian milk may not be adequate as it could not confer considerable protection to the infants as those extended by breast milk. With the objective of enhancing the nutritional and therapeutic attributes of humanized mammalian milk considerable efforts have been exercised to mimic infant formulae to the health‐promoting benefits of breast milk with the inclusion of probiotics, oligosaccharides and proteins. The purpose of this paper is to address this issue.

In the present article an endeavour has been made to enlighten innovations in supplementary foods for infants in absence of human milk. Suitability of special humanized milk such as hypoallergenic formulae, neural formulae and gastrointestinal integrity formulae as a supplementary food for infants in absence of human milk is also justified.

Characterization of components of human milk and identification of nutritional needs of infants have resulted in formulation of special humanized milk such as hypoallergenic formulae for allergenic infants, neural formulae for normal physiological functions of infants and gastrointestinal integrity formulae for maintaining microbial balance in the intestine. Supplementation of infant formulae with sialic acid, long chain poly unsaturated fatty acids such as decosahexaenoic acid and arachidonic acid, probiotic cultures such as Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus GG and Lactobacillus casei and prebiotic such as galacto‐OS and fructo‐OS are recommended.

The paper emphasises that, with the characterization of components of human milk and identification of nutritional needs of infants, modification of infant formulae should be constantly carried.

The aim of this study is to determine what changes occur in the health status of people with autism spectrum disorder (ASD) compared to neurotypical controls.

The authors performed a comparative analysis of data collected from 72 subjects with ASD and 75 neurotypical controls aged 3–24 years using the Rochester Health Status Survey IV (RHSS-IV). A structured individual interview was conducted to compare the health status of subjects in Macedonia.

A majority of people with ASD take vitamins, supplements and use recommended drug therapies compared to the neurotypical population and experience a larger number of side effects (p = 0.000). Compared to people with neurotypical development, children with ASD have a higher prevalence of oral ulcers (31.9% vs 17.3%; p = 0.039), changes in neurological health status – epilepsy (19.4% vs 2.7%; p = 0.001) and ADD/ADHD (only persons with ASD-19.4%; p = 0.000); respiratory diseases – angina (30.5% vs 8%; p = 0.000), rhinitis and/or sinusitis (40.3% vs 17.3%; p = 0.02); changes in the gastrointestinal system – constipation (31.9% vs 10.6%; p = 0.02), intestinal inflammation (19.4% vs 8%; p = 0.043), permeable intestines (only persons with ASD – 13.9%; p = 0.000) and the presence of the fungus Candida albicans (19.4% vs 4%; p = 0.043); psychiatric disorders – sleep problems (only in people with ASD – 18%; p = 0.000) and tics (6.9% vs 2.6%; p = 0.25) and skin diseases – eczema/allergic skin rash (36.1% vs 18.7%; p = 0.02).

Many children with ASD have health problems. These findings support and complement the professional literature on their mutual causality.