-
Mashup Score: 1Fifteen-minute consultation: Approach to a child with congenital insensitivity to pain - 18 hour(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.
Source: ep.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 5
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
Source: ep.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 13Development of a dedicated ‘drive-through’ pathway for neonates with bilious vomiting: a prospective cohort study - 2 day(s) ago
We report the findings of our multidisciplinary, polyperspective, collaborative quality improvement project. Infants with bile-stained vomit require an upper gastrointestinal (GI) contrast and review by a paediatric surgeon to exclude a midgut volvulus due to malrotation. Surgical and radiological findings of this potentially fatal condition1 are shown in figure 1. At our institution, a patient referred from a local neonatal unit (LNU) with bilious vomiting would be reviewed by the Southampton Oxford Neonatal Transport team (SONeT). SONeT would stabilise the baby and transfer to a surgical cot in the John Radcliffe Newborn Care Unit (NNU) where tertiary services are located. The baby would be prepared for contrast study; accompanied by two porters, a registrar and nurse to the …
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 16Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research - 2 day(s) ago
Objective Regarding the use of lung ultrasound (LU) in neonatal intensive care units (NICUs) across Europe, to assess how widely it is used, for what indications and how its implementation might be improved. Design and intervention International online survey. Results Replies were received from 560 NICUs in 24 countries between January and May 2023. LU uptake varied considerably (20%–98% of NICUs) between countries. In 428 units (76%), LU was used for clinical indications, while 34 units (6%) only used it for research purposes. One-third of units had 5 years of experience. LU was mainly performed by neonatologists. LU was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%). The main pathologies diagnosed by LU were pleural effusion, pneumothorax, transient tachypnoea of the newborn and respiratory distress syndrome.
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 2Retinopathy of prematurity comes full circle - 3 day(s) ago
In the 70 years since the first description, retinopathy of prematurity (ROP) has been the focus of intensive basic and clinical research. Over time, worldwide, there have been several phenotypes of ROP described. Here, we explore whether these are part of a single spectrum or are separate and distinct entities. First described in 1942 by Terry, clinical1 and experimental studies2 3 provided compelling evidence that ‘retrolental fibroplasia’—as ROP was then known—was related to uncontrolled oxygen exposure, although some acknowledged that the mechanism was likely complex. This led clinicians to the restriction of supplemental oxygen concentrations to less than 40%, with predictions that this would eliminate an important cause of infant blindness. Sadly, such forecasts were not fulfilled, and ROP-induced blindness still occurred. Subsequently with increasing preterm survival, the population developing ROP had ever decreasing gestational age. Other risk factors for ROP were recognised, l
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 6
Introduction There is insufficient evidence to determine if non-invasive transcutaneous bilirubin (TcB) measurement can replace serum bilirubin (SBR) in assessing rebound hyperbilirubinaemia after phototherapy. Objective To investigate if TcB can safely guide management of neonates after phototherapy. Subjects 100 well neonates ≥35 weeks’ gestation who had received inpatient phototherapy. Method Measurement of both helix (manufacturer’s recommendation) and earlobe TcB coincidentally with routine SBR 12 hours after cessation of phototherapy. All mothers gave written informed consent. Results Gestation ranged from 35+0 to 41+5 (median 37+6) weeks; birth weight 2018–4566 (median 3230) g; age 55–222 (median 109) hours at testing. 86% neonates were Caucasian. Outcomes determined by SBR included restarting phototherapy (n=0), repeat SBR next day (n=29), no further routine follow-up (n=71). TcB and SBR measurements were unpredictably inconsistent. Helix TcB tended to underestimate SBR (mean d
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
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
Source: ep.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 6
Objective To determine the accuracy of two developmental screening questionnaires to detect cognitive or language delay, defined using the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III), in children born extremely preterm (EP: <28 weeks’ gestation) or extremely low birth weight (ELBW: <1000 g). Design Prospective cohort study. Setting State of Victoria, Australia. Patients 211 infants born EP/ELBW assessed at 2 years’ corrected age (mean 2.2, SD 0.2). Main outcome measures Cognitive and language delay (<−1 SD) on the Bayley-III. The screening questionnaires were the Parent Report of Children’s Abilities-Revised (PARCA-R) and the Ages & Stages Questionnaires Third Edition (ASQ-3). Results The PARCA-R performed better than the ASQ-3, but neither questionnaire had substantial agreement with the Bayley-III to detect cognitive delay; kappa (95% CI): PARCA-R 0.43 (0.23, 0.63); ASQ-3 0.15 (−0.05, 0.35); sensitivity (95% CI): PARCA-R 70% (53%, 84%) ASQ-3 62% (47%, 7
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 6Parasitic infections: what do paediatricians need to know? - 5 day(s) ago
Parasitic infections and the medications used to treat them may be unfamiliar to many paediatricians. Parasitic infections, however, are not uncommonly seen in children in the UK. We summarise infections which are commonly seen, currently recommended treatment and practical guidance on formulations, adverse effects and treatment choice.
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
-
Mashup Score: 12Gastrointestinal effects of caffeine in preterm infants: a systematic review and Bayesian meta-analysis - 6 day(s) ago
Objective Caffeine is widely used in preterm infants to prevent or treat apnoea of prematurity. Adverse gastrointestinal effects of caffeine have not been thoroughly researched in preterm infants. With this systematic review and meta-analysis, we aim to summarise the results of trials on the gastrointestinal effects of caffeine in preterm infants. Design We searched MEDLINE, Web of Science, Scopus and ClinicalTrials.gov up to 21 April 2023. We included randomised controlled trials assessing caffeine versus placebo in preterm neonates and reporting gastrointestinal side effects. Risk of bias was assessed using the Cochrane Risk of Bias tool. A Bayesian meta-analysis was performed to estimate the pooled OR of gastrointestinal side effects. Results Nine trials involving 2746 preterm infants were analysed. Seven trials assessing necrotising enterocolitis and four trials assessing feeding intolerance in our meta-analysis found no differences between caffeine and placebo (OR=1.007 (95% credi
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
15-minute consultation: Approach to a child with congenital insensitivity to pain Rare, but important to recognise Some associated genetic syndromes https://t.co/x6IEajkvAu https://t.co/OtI2bNJWte