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Mashup Score: 3Neonate with a large neck mass - 10 hour(s) ago
A male term infant, with polyhydramnios, was delivered by caesarean section. Family history included a sibling with Edward’s syndrome. He required non-invasive respiratory support at birth and was admitted to the neonatal unit. A raised occipital mass was noted (figure 1), measuring 8×6 cm, with central yellow pallor and surrounding margins of purple convoluted friable skin and overlying telangiectasia. There was a strong palpable pulse felt above the mass. Figure 1 Large neck swelling noted on base of occiput. The baby remained haemodynamically stable (admission blood pressure 69/37mmhg) with normal values for both haemoglobin (152 g/L) and platelet count (149×109/L). He was transferred to a tertiary hospital where ultrasound (USS) demonstrated a mass with high intralesional vascular flow (figure 2). MRI demonstrated a large congenital vascular anomaly within the posterior neck soft tissues and identified large feeding and draining vessels. Figure 2 B-mode ultrasound image …
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Mashup Score: 2Fifteen-minute consultation: Approach to a child with congenital insensitivity to pain - 1 day(s) ago
The hereditary sensory and autonomic neuropathies (HSANs) are a group of rare genetic disorders characterised by variable phenotypic expression affecting both sensory and autonomic dysfunction. Diagnosing these conditions can be a challenge as the presenting symptoms can be diverse and may overlap. This often leads to a delay in referral and diagnosis. Pain is often used by clinicians as a marker for systemic diseases. The key feature of HSAN conditions is the absence of pain perception and its consequences such as unexplained injuries. When a child presents with an unexplained injury, a diagnosis of non-accidental injuries must be considered, but rarely HSAN could be a possibility. The diagnosis of HSANs in children is both important and rare. This article aims to discuss an approach to the diagnosis and management of HSANs.
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Mashup Score: 7
Mechanically ventilated neonates are prone to unplanned extubation (UE) or accidental extubation causing cardiorespiratory deterioration, hypoxia and need for resuscitation.1 Repeated reintubation may result in airway trauma, subglottic stenosis, prolonged ventilation, prolonged hospital stay and increased risk of infection.2 Studies have shown a variation in the rate of UE in neonatal intensive care unit (NICU) from 1.14 to 5.3 per 100 ventilation days.3 Reasons for the increased incidence of UE in neonates include longer duration of intubation, shorter neonatal tracheal length, less routine use of sedation, procedures such as suctioning, the use of uncuffed endotracheal tubes and the method of fixation due to fragile skin.4 Bedside activities such as weighing, kangaroo care, procedures like line placements, scans/imaging, phlebotomy and transportation of babies are potential risk factors for UE.3 5 UE is not uncommon in the NICU but we noticed multiple UEs in our NICU leading to re-i
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Mashup Score: 66Use of corticosteroids for croup in children - 4 day(s) ago
### Key points A 2-year-old child is brought to the emergency department with a barking cough, subcostal recessions and intermittent stridor. Concerned about the symptoms, their parents are asking for the best possible treatment to improve the symptoms and reduce the need for further treatment or admission. In any child presenting with stridor, it is important to consider a wide range of differentials (table 1).1 Croup (also called laryngotracheitis) is a common cause of stridor and upper airway obstruction in children aged 6–36 months.2 Croup usually occurs in the winter months and is most frequently caused by human parainfluenza virus types 1 and 2; less commonly, other respiratory viruses, such as respiratory syncytial virus, can also cause croup.2 Recently, SARS-CoV-2 has emerged as a cause and can often occur in an older demographic of children.3–6 Research involving large cohorts of children with croup has demonstrated that only a small proportion require hospital admission.1 6 T
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Mashup Score: 5Acute Safeguarding Essentials in Modern-day Paediatrics: Sexual Relationships, Consent and Confidentiality - 16 day(s) ago
As the third case in the acute safeguarding essentials in modern-day paediatrics series, this article focuses on sexual relationships, consent and confidentiality. Using the scenario of a 15-year-old girl presenting to the emergency department with a positive pregnancy test, it begins with a guide to taking a psychosocial history in young people followed by discussion about some of the legality surrounding sexual relationships in adolescents, issues around consent and considerations for confidentiality in this age group.
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Mashup Score: 11
### Key messages Aminoglycosides are a class of broad-spectrum, bactericidal antibiotics of which amikacin, gentamicin and tobramycin are the most commonly prescribed. These antibiotics are frequently prescribed for children, usually for infections, which are caused by aerobic Gram-negative pathogens. 1 Aminoglycosides are very poorly absorbed from the gastrointestinal tract, due to their lack of lipophilicity. Therefore, they must be administered parenterally. They are also concentration dependent, which means that the ratio between the peak concentrations (Cmax) to the pathogen’s minimum inhibitory concentration (MIC) is the pharmacokinetic-pharmacodynamic index, which is a marker for antimicrobial activity and effectiveness. To achieve an effective clinical response, a Cmax/MIC ratio between 8 and 12 has been advised, although this is based on adult data.1 Aminoglycosides have a narrow therapeutic margin, so therapeutic drug monitoring must be used to monitor for toxicity. High seru
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Mashup Score: 3
(19 March, 2024) Free Neelam Gupta (5 December, 2022) Amanda Fenech, Nikki Baatjes, Kavitha Gunasuntharam (19 January, 2023) Free Alexandra Selina Cross, Manar Moustafa, Charlotte Jane Elder (8 November, 2022) Daniel Cromb, Malgorzata Radomska, Nandu Thalange, Paul Cawley (29 September, 2022) Miriam R Fine-Goulden, Jon Lillie (11 August, 2022) Free Umar F Mahmood, Gregory J Skinner (13 October, 2023) Abhishek Oswal, Gangadhara Bharmappanavara, Georgia Spentzou (1 February, 2024) Rhiannon McBay-Doherty,
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Mashup Score: 0Public health for paediatricians: how an evolutionary perspective can help us improve children’s well-being - 28 day(s) ago
Humans lived as hunter-gatherers for 95% of our 200 000-year history.1 Social scientists call our modern societies ‘WEIRD’: Western, Educated, Industrialised, Rich and Democratic.1 In evolutionary terms, the last 10 000 years that we have not lived as hunter-gatherers is brief. Dobzshansky2 famously stated that ‘Nothing makes sense in biology, except in the light of evolution’. This is also true for medicine and for paediatrics. We suggest that it is important for paediatricians to consider the evolutionary view, as small adjustments from a public health perspective might make it easier for children to thrive. See Box 1 for some key evolutionary concepts, which we discuss in greater detail in the following sections. Box 1 ### : Key concepts in evolutionary science
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Mashup Score: 9
Precocious puberty has traditionally been defined as the onset of secondary sexual characteristics occurring before age 8 years in girls and 9 years in boys. This earlier onset of puberty may have significant physical and psychological consequences if left untreated. Moreover, it should be excluded that pubertal signs are not secondary to malignancies, other organic aetiologies or associated syndromic phenotypes. Initial assessment involves a thorough medical history and physical examination; a hand and wrist X-ray to determine bone age, and hormonal tests might be indicated to confirm the diagnosis and to determine the origin of hormonal production. Treatment options depend on the underlying cause. Given the complexity of the differential diagnosis, this article aims to familiarise clinicians with the different steps that can be taken when precocious puberty is suspected.
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Mashup Score: 1
(19 March, 2024) Free Neelam Gupta (5 December, 2022) Amanda Fenech, Nikki Baatjes, Kavitha Gunasuntharam (19 January, 2023) Free Alexandra Selina Cross, Manar Moustafa, Charlotte Jane Elder (8 November, 2022) Daniel Cromb, Malgorzata Radomska, Nandu Thalange, Paul Cawley (29 September, 2022) Miriam R Fine-Goulden, Jon Lillie (11 August, 2022) Free Umar F Mahmood, Gregory J Skinner (13 October, 2023) Abhishek Oswal, Gangadhara Bharmappanavara, Georgia Spentzou (1 February, 2024) Rhiannon McBay-Doherty,
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Neonate with a large occipital mass (Consent obtained parent/guardian) What to do? Read here👇 https://t.co/Sn97nZT6g3 https://t.co/6qHSHHgJjE