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audit on the use of oral baclofen in children with cerebral palsy attending warrington cdc n.
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AUDIT ON THE USE OF ORAL BACLOFEN IN CHILDREN WITH CEREBRAL PALSY ATTENDING WARRINGTON CDC

AUDIT ON THE USE OF ORAL BACLOFEN IN CHILDREN WITH CEREBRAL PALSY ATTENDING WARRINGTON CDC

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AUDIT ON THE USE OF ORAL BACLOFEN IN CHILDREN WITH CEREBRAL PALSY ATTENDING WARRINGTON CDC

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  1. AUDIT ON THE USE OF ORAL BACLOFEN IN CHILDREN WITH CEREBRAL PALSY ATTENDING WARRINGTON CDC Dr B George

  2. Aim • To identify various factors affecting usage. • To identify existing regimes of prescription. • To document benefits and side effects. • To identify existing or prevalent guidelines on oral prescription.

  3. Methods • List of all children registered as ICD-10 (G80-83) codes as having cerebral palsy under the Warrington CDC. Obtained from IT (medical records) at Warrington CSU. • Notes retrieved and children currently or previously on Baclofen identified. • Data collated on above sub-set.

  4. Total children registered with CP 78 • Total notes obtained 43 • Children with CP on analysis 42 • Children currently on Baclofen 09 • Children previously on Baclofen 02

  5. ‘n’ total no 11 • % of children with CP on Baclofen is 11/42 = 26.2% • Avg age of our sub group 10y 1m • Avg age at diagnoses 30 m • Males 8 • Females 3

  6. Body pattern involvement • Diplegia 3 • Quad/tetraplegia 3 • Hemiparesis/plegia 1 • Undiagnosed syndrome 2 • CP -unspecified 2

  7. Etiology • Asphyxia 8 • Syndrome (Undiagnosed) 2 • Unspecified 1

  8. Movt problems • Spasticity 10 • Dystonia 1

  9. Co-morbidities

  10. Therapies • Physiotherapy • Occupational therapy • Speech & language

  11. Other medications

  12. Baclofen – data Freq • ODS 1 • BDS 3 • TDS 6 • QDS 1

  13. BNF • BNF advises 0.75 mg – 2 mg/kg daily or 2.5 mg q.d.s increased gradually to maintainence. • Child 1–2 years 10–20 mg daily in divided doses, Child 2–6 years 20–30 mg daily in divided doses, Child 6–10 years 30–60 mg daily in divided doses • Child 10–18 years 5 mg 3 times daily increased gradually; max. 2.5 mg/kg or 100 mg daily

  14. BNF • BNF advises 0.75 mg – 2 mg/kg daily or 2.5 mg q.d.s increased gradually to maintainence. • Child 1–2 years 10–20 mg daily in divided doses, Child 2–6 years 20–30 mg daily in divided doses, Child 6–10 years 30–60 mg daily in divided doses • Child 10–18 years 5 mg 3 times daily increased gradually; max. 2.5 mg/kg or 100 mg daily

  15. Side effects • Nil 7 • KK- stopped as no response(no s.e.) • MW - stopped as worsening reflux • DM – vomiting, • JC -- decreased appetite • VR-Increasing spasticity, stopped walking unaided, swallowing diff---dose reduced

  16. Conclusions • All patients prescribed for increasing hypertonia. • No standardised regime of prescription identified-i.e. starting regime, increasing dosage, frequency. • All mg/kg dosages were within BNF limits. • Some side-effects noted, mainly increasing feeding problems and reflux. ?statistical significance due to small numbers. • No guidelines identified in literature search specifically for oral Baclofen prescription.

  17. RECOMMENDATIONS • To propose a regional standardised regime for prescription. • To generate information/advice sheet on Baclofen for prescribers in the hospitals and community. • To generate clinic sheet for prescribers to document information on Baclofen on the first and then on each clinic visit.

  18. THANK YOU