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First do no harm…
  1. F McErlane
  1. Royal Liverpool Children’s Hospital, Eaton Road, Liverpool L12 2AP, UK; florapeterlittler.co.uk

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    A 9 day old infant presented to hospital with an erythematous, diffusely swollen right foot, shown in figs 1 and 2.

    The infant had been slow to establish breast feeding and was not discharged from hospital until day 7 of life. Her father had noticed the inflamed foot during a nappy change earlier that morning. Both parents felt the infection was the result of a tight hospital name band. The firm plastic band had caused small lacerations to the right ankle prior to its removal.

    Hospital name bands are useful in the identification of patients prior to the administration of drugs and are a simple tool in the prevention of abduction from hospital.1 It can be very difficult to fasten the bands tightly enough for them to remain attached but not cause superficial lacerations, particularly if the child has dry, peeling skin. These bands can frequently be found adorning the floor or discarded items of clothing on postnatal wards.

    As paediatricians we are urged to place the child’s best interests at the centre of all clinical considerations. We have a responsibility to safeguard the reputation of paediatrics through our personal clinical practice. This child had an iatrogenic injury following a non-essential intervention resulting in hospital readmission. She received a full course of antibiotics, exposing her to the well documented risks of allergic reaction, nephrotoxicity, and vestibular and auditory damage.

    Perhaps it is time for us to reconsider techniques for the attachment of hospital name bands to newborn infants. Although name bands could be manufactured using softer materials, this would increase the ease with which such bands could be removed or switched. A more practical suggestion would be to label cord clamps with an identifier. Cord clamps do not fall off and cannot easily be removed by non-medical personnel. This technique could be combined with security tags, footprinting, and the retention of cord blood samples at individual hospitals’ discretion.

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    Footnotes

    • Consent has been obtained for figures 1 and 2

    • Competing interests: none declared

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