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Mashup Score: 12Episode 80: Dexmedetomidine for paediatric sedation - 1 day(s) ago
We talk to Dr Tom Jackson about his article in Archives of Disease in Childhood looking at the use of Dexmedetomidine as a sedative agent fro children undergoing MRI scans in a district general hospit
Source: soundcloud.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 2Clinical application of paediatric serum troponin T testing - 3 day(s) ago
Cardiac ischaemia is rare in children, and acute presentations of chest pain are multifactorial. Serum troponin testing may be used to aid diagnosis of suspected cardiac ischaemia in both children and adults; however, the literature suggests there is limited value in serum troponin testing in paediatric patients presenting with chest pain.1 2 We conducted a single-centre review of all troponin T (TnT) laboratory requests from paediatric patients up to their 16th birthday from 19 September 2017 to 21 September 2022. 354 samples were included in the final analysis. Table 1 describes the yield of elevated serum troponin results based on common presenting complaints and the subsequent incidence of a cardiac diagnosis. A serum TnT>10 ng/L was considered elevated based on the …
Source: adc.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 9Severe case of aplasia cutis congenita - 3 day(s) ago
A male infant was born at 35+6 weeks’ gestation to a 19-year-old woman by vaginal delivery after spontaneous onset of labour. There had been limited antenatal care within the UK with previous care in East Africa. Parents are non-consanguineous. The antenatal ultrasound at 34+5 weeks in the UK was normal. After birth, the infant was noted to have a large defect on the right temporo-parieto-occipital region of …
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 3Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study - 4 day(s) ago
Objective To (1) describe differences in types and timing of interventions, (2) report short-term outcomes and (3) describe differences among centres from a large national cohort of preterm infants with post-haemorrhagic hydrocephalus (PHH). Design Cohort study of the Children’s Hospitals Neonatal Database from 2010 to 2022. Setting 41 referral neonatal intensive care units (NICUs) in North America. Patients Infants born before 32 weeks’ gestation with PHH defined as acquired hydrocephalus with intraventricular haemorrhage. Interventions (1) No intervention, (2) temporising device (TD) only, (3) initial permanent shunt (PS) and (4) TD followed by PS (TD-PS). Main outcome measures Mortality and meningitis. Results Of 3883 infants with PHH from 41 centres, 36% had no surgical intervention, 16% had a TD only, 19% had a PS only and 30% had a TD-PS. Of the 46% of infants with TDs, 76% were reservoirs; 66% of infants with TDs required PS placement. The percent of infants with PHH receiving v
Source: fn.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 0Are toddlers with neurosensory impairment more difficult to follow up? A secondary analysis of the hPOD follow-up study - 4 day(s) ago
Objective To describe strategies used to maximise follow-up after a neonatal randomised trial, how these differed for families of different ethnicity, socioeconomic status and urban versus rural residence and investigate relationships between the difficulty of follow-up and rate of neurosensory impairment. Method hPOD was a multicentre randomised trial assessing oral dextrose gel prophylaxis for neonatal hypoglycaemia. Follow-up at 2 years was conducted from 2017 to 2021. We analysed all recorded contacts between the research team and participants’ families. Neurosensory impairment was defined as blindness, deafness, cerebral palsy, developmental delay or executive function impairment. Results Of 1321 eligible participants, 1197 were assessed (91%) and 236/1194 (19.8%) had neurosensory impairment. Participants received a median of five contacts from the research team (range 1–23). Those from more deprived areas and specific ethnicities received more contacts, particularly home tracking
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Mashup Score: 4Neonate with a large neck mass - 5 day(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 …
Source: ep.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 2Fifteen-minute consultation: Approach to a child with congenital insensitivity to pain - 5 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.
Source: ep.bmj.comCategories: General Medicine News, General Journals & SocietTweet
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Mashup Score: 8
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
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Mashup Score: 13Development of a dedicated ‘drive-through’ pathway for neonates with bilious vomiting: a prospective cohort study - 6 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
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Mashup Score: 16Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research - 7 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
RT @2_paeds: Our latest episode is now live!! Fed up of failed sedated MRI scans? We may have the answer… https://t.co/LwDwXAuFEJ @rcpch…