Paediatrics and Child Health

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Updated: 1 hour 7 min ago

A review of growth hormone deficiency

Tue, 06/11/2019 - 00:00
Growth hormone deficiency (GHD) is a rare but important cause of short stature in children. It is treatable. However, diagnosis is challenging and often requires referral to a specialist paediatric endocrinologist to facilitate testing and the interpretation of results. Careful history and examination with meticulous auxology data are critical components of the initial evaluation in clinic. Thereafter, further investigations are required to exclude other causes of short stature, and to establish the diagnosis.
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Von Willebrand disease: diagnosis and management

Mon, 06/10/2019 - 00:00
Von Willebrand Disease is a common cause of excessive bruising and bleeding in children. This short article gives advice on diagnosis and management for paediatricians. Given its prevalence and presenting symptoms, VWD should always be considered in the assessment of children suspected of non-accidental injury. Its diagnosis can be challenging, not only because of the various subtypes of the disorder but because of the considerable overlap between VWD and normal individuals. Laboratory diagnosis requires a range of quantitative and qualitative tests of the VWF protein, with targeted gene analysis increasingly used to confirm the diagnosis of type 2 and type 3 VWD.
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Management of haemophilia in children

Sat, 06/01/2019 - 00:00
Haemophilia is an inherited bleeding disorder associated with a reduction or absence of coagulation factor VIII or IX. In severe haemophilia, recurrent, spontaneous bleeding occurs into joints, without treatment this leads to crippling joint deformity. Haemophilia is an X-linked disorder yet there is no family history in approximately one third of cases where haemophilia arises as a result of a new genetic mutation. Without treatment, the prognosis is poor but the development of factor concentrates and ‘non-factor replacement therapy’ has transformed the outlook.
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Editorial Board

Sat, 06/01/2019 - 00:00
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A simple model for understanding the causes of paediatric wheeze

Fri, 05/31/2019 - 00:00
Wheeze is one of the most common paediatric presentations. While there are only a few possible reasons for a child to develop wheeze, there is often diagnostic uncertainty between common causes such as bronchiolitis, viral wheeze and asthma. The evidence shows that these conditions respond differently to the treatments available. This means that better differentiation should have a beneficial effect through more appropriate and targeted disease management. This article describes my personal model for understanding why these three conditions occur at different ages and respond to different treatments.
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A practical approach to recurrent epistaxis in children

Mon, 05/20/2019 - 00:00
Recurrent epistaxis (nose bleeds) are common in children. The vast majority of nose bleeds are self-resolving and do not require medical input. Clinicians get involved in cases where the nose bleeds are more severe, frequent and take a longer time to resolve. Emergency management involves basic resuscitation and first aid measures. A holistic approach is required, when dealing with non-emergency cases of frequent nose bleeds, including the exclusion of systemic illness. In this article we outline the basic history, examination, investigation and management aspects of evaluating a paediatric patient with epistaxis.
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Managing headache

Thu, 05/16/2019 - 00:00
Managing headache involves being able to make a positive diagnosis of the headache type, reassuring the family that there is no serious underlying cause and enabling self-management. Resisting the urge to investigate is also important.
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Assessing tall stature

Tue, 05/14/2019 - 00:00
Children and adults are considered ‘tall’ when their height is above 98th centile for age i.e. 2 standard deviations (SD) above the mean. Tall stature is familial in most cases. In assessing children with tall stature the mid-parental height centile should always be calculated and this article gives advice on how to proceed with investigation and management for children who are unexpectedly tall. Other common causes of tall stature are obesity or early normal puberty. Precocious puberty, hyperthyroidism and GH excess are less common but these will also cause rapid height velocity at any age and precocious puberty should be excluded in every child presenting with tall stature.
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Checklists in action in neonatal medicine: improving breastfeeding rates

Wed, 05/08/2019 - 00:00
Checklists were initially used within the aviation industry before being extrapolated into a number of other industries and arriving much later to medicine, where they are used as tools to improve patient safety. Checklists improve reliability, reduce variation and standardise care, ensuring that staff can review their tasks and confirm compliance before moving on to the next step. They have flexibility in application and are used in both within the acute care setting, in addition to service planning and delivery.
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Graves’ disease

Tue, 05/07/2019 - 00:00
Graves' disease develops when pathogenic thyroid receptor antibodies stimulate the thyroid gland resulting in excessive thyroid hormone production. Children and adolescents with Graves' disease can present in a variety of ways to many different clinical teams with a diverse range of underlying symptoms and signs. Graves' disease is usually managed initially with the anti-thyroid drug (ATD) carbimazole. However, only 20–25 % of young patients remit (remaining euthyroid when the ATD is stopped in the longer term) after a 2 year course of ATD treatment.
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Management of teenagers with polycystic ovarian syndrome

Tue, 05/07/2019 - 00:00
Polycystic ovary syndrome (PCOS) is a common, complex endocrine and metabolic disorder with a prevalence of 20%. It is variable in aetiology, clinical presentation and prognosis, making it a challenging disease to understand and manage in teenagers. It results from a defect in steroidogenesis, leading to excess luteinising hormone and hyperandrogenism. PCOS is also associated with insulin resistance and compensatory hyperinsulinism. The Rotterdam criteria are the most widely used criteria for diagnosing PCOS, however it is typically challenging to diagnose in teenage girls due to the overlap of symptoms with normal pubertal changes.
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Editorial Board

Wed, 05/01/2019 - 00:00
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Self-assessment

Tue, 04/30/2019 - 00:00
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Review of resuscitation physiology in children

Tue, 04/30/2019 - 00:00
More than one quarter of children survive to hospital discharge after in-hospital cardiac arrests, and 5–10% of children survive to hospital discharge after out-of-hospital cardiac arrests. Cardio-pulmonary resuscitation (CPR) differs in children from adults. Following the Airway, Breathing, Circulation format, this article reviews the physiology of paediatric cardio-pulmonary resuscitation. It addresses the appropriate interventions during CPR, mechanisms of action of commonly used drugs and special resuscitation circumstances: premature and newly born infants, traumatic cardiac arrest, and ECMO (Extracorporeal Membrane Oxygenation).
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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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