Paediatrics and Child Health

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Updated: 5 hours 42 min ago

Sedation and analgesia for critically ill children

Mon, 04/15/2019 - 00:00
Effective analgesia and sedation in the paediatric intensive care unit (PICU) encompasses the provision of physical comfort and caring for the psychological well-being of critically ill children. In the UK the most commonly used sedative and analgesic agents for critically ill children are midazolam and either morphine or fentanyl. Consensus clinical practice guidelines for the provision of sedation and analgesia in critically ill children were published in 2006 by the UK Paediatric Intensive Care Society, and an ESPNIC position statement on clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children was published in 2016: Despite this, considerable variation in practice persists.
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Preterm patent ductus arteriosus: what the research tells us

Fri, 04/12/2019 - 00:00
Ductus arteriosus is a fetal blood vessel that connects two elastic arteries, pulmonary artery and aorta, with different resistances. It only becomes pathological if it fails to close after birth. The clinical features of patent ductus arteriosus (PDA) depend upon the gestation at birth, severity of lung disease and the postnatal age of the newborn. In premature infants, PDA is associated with significant morbidity and mortality. However, the current literature on treatment of PDA does not report any improvement in long-term neonatal outcomes.
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The role of ECMO in neonatal and paediatric patients

Fri, 04/12/2019 - 00:00
ECMO or extracorporeal membrane oxygenation has now been part of healthcare for over 40 years. During that time, changes in circuit technology have resulted in improved survival and have facilitated the use of ECMO in more challenging patient groups in whom ECMO was previously considered to be contraindicated. Further advances have allowed ECMO to progress out of the specialist centres and nearer to patients, in the form of mobile ECMO. Patient selection remains key to a successful outcome since ECMO is a supportive therapy utilised whilst waiting for a reversible condition to resolve through other treatment strategies.
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Mechanism of action of inotropes in neonates

Sat, 04/06/2019 - 00:00
Whilst inotropes have been used in the neonatal intensive care unit (NICU) for over 50 years, debate on the optimal management of neonatal hypotension continues. The complex biochemical processes involved often mean these medications produce effects which seem to be contrary to expectations. The changing haemodynamics during the transitional phase of the newborn period, along with the gestation related structural and functional immaturity of the cardiovascular system, makes choosing an inotrope difficult.
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Antibiotic stewardship in the neonatal intensive care unit

Fri, 04/05/2019 - 00:00
Antibiotic stewardship (ABS) refers to the coordinated interventions to appropriately prescribe and administer the most pathogen-specific, narrow-spectrum antibiotic regimens, in the correct doses, for the appropriate duration, and continually evaluate prescriber and administration compliance. The main historical driver for ABS has been antibiotic resistance, which is fuelled by antibiotic therapy. Additionally, short and long term consequences of antibiotic therapy on the developing immune system have emerged as further specific hazards of antibiotic exposure in neonates.
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Neonatal sepsis

Thu, 04/04/2019 - 00:00
Neonatal sepsis is a cause of significant mortality and morbidity. It can be early (less than 72 h) or late onset (more than 72 h age). Group B Streptococcus (GBS) is the leading cause of early onset neonatal sepsis (EONS). Risk factors include maternal sepsis, prolonged rupture of membranes, chorioamnionitis and GBS colonization. Risk-based predictive models are used to identify and screen infants. Late onset neonatal sepsis (LONS) is largely caused by gram positive organisms. Risks for LONS include prematurity, low birth weight and common neonatal interventions and procedures.
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Editorial Board

Mon, 04/01/2019 - 00:00
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Self-assessment

Sat, 03/30/2019 - 00:00
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Management of the potential paediatric organ donor

Thu, 03/28/2019 - 00:00
Paediatric organ donors remain a critically scarce and precious resource at a time of ever increasing demand for donor organs. The early recognition and management of the potential paediatric organ donor can increase the number of viable donor organs available. Managing the cardiovascular instability that follows brain death requires a systematic intensive care approach in order to preserve viability of the potential donor organs. Careful consideration of the fluid status and inotrope requirements in addition to supplementation of the hormonal and haematological axes helps to optimize tissue perfusion.
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Respiratory support in children

Fri, 03/15/2019 - 00:00
Respiratory failure is defined by the inability of the respiratory system to adequately deliver oxygen or remove carbon dioxide from the pulmonary circulation resulting in hypoxemia, hypercapnia or both. A wide variety of disease processes can lead to respiratory failure in children. Multiple interventions can support the paediatric patient with respiratory failure, from simple oxygen delivery devices to high frequency oscillatory ventilation and extracorporeal membrane oxygenation. This article will review available devices to improve oxygenation and ventilation, their advantages and disadvantages, and help guide physicians in the management of children with respiratory failure.
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Long-term ventilation in children

Thu, 03/07/2019 - 00:00
Long-term ventilation (LTV) is now an accepted treatment for children with a wide variety of conditions. Respiratory support can be delivered via a mask or a tracheostomy and can range from CPAP to treat obstructive sleep apnoea, to 24 hour a day sophisticated invasive ventilation. Patient numbers are increasing out of proportion to population growth, suggesting that more children are being supported due to changes in societal expectation, improved survival in PICU, and the availability of more advanced ventilators.
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Editorial Board

Fri, 03/01/2019 - 00:00
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The young athlete with dyspnoea

Fri, 03/01/2019 - 00:00
Problematic dyspnoea in young athletes is most commonly due to either exercise induced asthma, exercise induced laryngeal obstruction or a breathing pattern disorder. Pathologies that affect the physiological processes involved in the transport of oxygen from ambient air through to the working muscles can also cause dyspnoea. Other factors including psychology, environmental and sport specific factors can contribute. This review highlights the value of a systematic approach to a young person with difficulty in breathing as a result of exercise.
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The child with the large head

Fri, 03/01/2019 - 00:00
Macrocephaly is usually a benign condition that does not require intervention. Presenting in infancy, it is commonly due to familial macrocephaly (FM). However, there are some underlying pathologies that clinicians need to be aware of and exclude prior to reassuring parents. This review aims to give a practical approach to assessing the child with the large head and identify features that warrant further investigations.
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Catheter-associated bloodstream infections

Wed, 02/27/2019 - 00:00
Each year an estimated quarter million central venous catheters (CVCs) are inserted in the UK for monitoring, delivery of drugs or intravenous feeding and blood sampling in patients receiving critical care. CVCs are indispensable, but the reported rate of catheter associated bloodstream infection (CA-BSI) is high with an incidence varying between 0.46 and 26.5 per 1000 CVC days. CA-BSI is an important cause of adverse clinical outcome, with associated morbidity and mortality, and an additional increased economic cost to the National Health Service.
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Management of meningococcal disease

Wed, 02/27/2019 - 00:00
In recent years remarkable progress has been made in the development of vaccines against the different disease-causing serotypes of Neisseria meningitidis. Despite this, invasive meningococcal disease (IMD) remains a life-threatening illness with significant mortality, morbidity and long term sequelae. Prompt recognition and early treatment with antibiotics are the first steps in its management. Professionals looking after children with suspected IMD should be familiar with its clinical course, so that progression of the disease can be identified early, and its complications including septic shock, coagulopathy and raised intracranial pressure managed aggressively.
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When is difficult asthma severe?

Wed, 02/27/2019 - 00:00
Asthma is the commonest childhood chronic disease in the UK. Most children with asthma are classed as having mild to moderate disease. Regular treatment with inhaled steroids and bronchodilators are enough to successfully control the symptoms. A small proportion of asthmatic children continue to have sub-optimal control despite apparent appropriate therapy (problematic asthma). Most of these children have modifiable factors resulting in poor asthma control (difficult asthma). True therapy-resistant asthma is rare in children and the paediatric community should focus on ensuring the correct diagnosis, identifying and managing modifiable risk factors before using the label severe asthma.
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Newborn screening for inborn errors of metabolism

Sat, 02/23/2019 - 00:00
The aim of screening is to identify newborns who appear healthy but could be at risk of developing rare conditions that can lead to serious complications and if left untreated even death (table 1). The need for prompt and effective intervention in screen positive patients is particularly important in cases of inherited metabolic diseases (IMD). These conditions often have complex or urgent needs and evidence suggests that outcome may be strongly influenced by referral and treatment pathways. Referrals of all IMD screen positive patients are undertaken in co-ordination with a paediatric IMD centres across the UK.
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Self-assessment

Thu, 02/21/2019 - 00:00
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Phenylketonuria

Mon, 02/18/2019 - 00:00
Phenylketonuria remains one of the most common inborn errors of metabolism. In the UK it is detected on the newborn heel-prick screening sample allowing early treatment with a strict low phenylalanine diet supplemented with artificial amino acids and appropriate vitamin and minerals. Although the long-term prognosis is good, there is an increasing body of evidence highlighting subtle problems in neuropsychological function with slower reaction times and poorer executive function than peers. White matter changes clearly seen on brain magnetic resonance imaging may have some relationship to these neuropsychological difficulties but their significance is not clearly understood.
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