Pub Date : 2025-02-01DOI: 10.1016/j.paed.2024.11.001
Rami Dhillon
All doctors need to be able to interpret an electrocardiogram (ECG). For a non-invasive test the ECG can deliver great rewards to those prepared to invest in its promise. It holds the potential of distinguishing normal from abnormal in the investigation of common presentations such as heart murmurs and palpitations. In more acute situations, correct interpretation offers a keen understanding of disturbances of rhythm and conduction. This article examines the utility of this modest but potent tool.
{"title":"Paediatric ECG made even easier","authors":"Rami Dhillon","doi":"10.1016/j.paed.2024.11.001","DOIUrl":"10.1016/j.paed.2024.11.001","url":null,"abstract":"<div><div>All doctors need to be able to interpret an electrocardiogram (ECG). For a non-invasive test the ECG can deliver great rewards to those prepared to invest in its promise. It holds the potential of distinguishing normal from abnormal in the investigation of common presentations such as heart murmurs and palpitations. In more acute situations, correct interpretation offers a keen understanding of disturbances of rhythm and conduction. This article examines the utility of this modest but potent tool.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 2","pages":"Pages 41-46"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.paed.2024.11.004
Hannah Pool
In-situ simulation is simulation-based education which is integrated into the clinical environment rather than in a dedicated training venue. It is used to improve clinical care, team dynamics and leadership as well as evaluate system issues and identify latent threats in the environment.
Designing a simulation, whether impromptu or planned, is crucial to its success. Considering the scenario and learning outcomes, location, equipment required and ensuring the right facilitators are available is essential. A simulation proforma can help to structure and deliver a successful session. It is important to create a supportive educational environment where participants feel comfortable and there is open debrief which identifies key learning for individuals, the department and wider system.
Embedding simulation into a department can be challenging but equally rewarding and lead to improvements in team performance and communication.
{"title":"‘Let's pretend’ in paediatrics: in situ simulation in practice","authors":"Hannah Pool","doi":"10.1016/j.paed.2024.11.004","DOIUrl":"10.1016/j.paed.2024.11.004","url":null,"abstract":"<div><div>In-situ simulation is simulation-based education which is integrated into the clinical environment rather than in a dedicated training venue. It is used to improve clinical care, team dynamics and leadership as well as evaluate system issues and identify latent threats in the environment.</div><div>Designing a simulation, whether impromptu or planned, is crucial to its success. Considering the scenario and learning outcomes, location, equipment required and ensuring the right facilitators are available is essential. A simulation proforma can help to structure and deliver a successful session. It is important to create a supportive educational environment where participants feel comfortable and there is open debrief which identifies key learning for individuals, the department and wider system.</div><div>Embedding simulation into a department can be challenging but equally rewarding and lead to improvements in team performance and communication.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 2","pages":"Pages 65-67"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.paed.2024.11.005
Nisha Aggarwal, Qasim Malik, Asad Abbas
This article serves as a guide to navigating any clinician's first neonatal job, offering practical tips across all areas including neonatal intensive care, the special care baby unit and the postnatal ward. Whilst it focuses on the training landscape for paediatricians in the UK, it may be more widely applicable. It emphasizes the importance of prioritizing patient care through effective teamwork, communication, and regular check-ins with colleagues, especially during high-pressure situations such as births. Key practical skills, including airway management, blood gas interpretation, and procedural training, are discussed, along with strategies for obtaining workplace-based assessments. Importantly, the piece reinforces the value of support systems available to trainees, including mentorship from senior colleagues and interdisciplinary collaboration. Ultimately, whilst aneonatal rotation can be daunting, it offers invaluable opportunities for professional growth, equipping trainees with essential skills and knowledge to navigate the challenges of neonatal care confidently.
{"title":"How to survive your first neonatal job","authors":"Nisha Aggarwal, Qasim Malik, Asad Abbas","doi":"10.1016/j.paed.2024.11.005","DOIUrl":"10.1016/j.paed.2024.11.005","url":null,"abstract":"<div><div>This article serves as a guide to navigating any clinician's first neonatal job, offering practical tips across all areas including neonatal intensive care, the special care baby unit and the postnatal ward. Whilst it focuses on the training landscape for paediatricians in the UK, it may be more widely applicable. It emphasizes the importance of prioritizing patient care through effective teamwork, communication, and regular check-ins with colleagues, especially during high-pressure situations such as births. Key practical skills, including airway management, blood gas interpretation, and procedural training, are discussed, along with strategies for obtaining workplace-based assessments. Importantly, the piece reinforces the value of support systems available to trainees, including mentorship from senior colleagues and interdisciplinary collaboration. Ultimately, whilst aneonatal rotation can be daunting, it offers invaluable opportunities for professional growth, equipping trainees with essential skills and knowledge to navigate the challenges of neonatal care confidently.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 2","pages":"Pages 68-70"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart murmur is the commonest reason for referral to paediatric cardiology services. Although congenital heart disease (CHD) is common, affecting between 6 and 10 in 1000 live births most heart murmurs are innocent. This is particularly likely in the absence of any cardiac symptoms. When a murmur is heard, it is important to be able to determine which children need urgent assessment by specialist services and which ones can safely wait for a more routine evaluation. Appropriate information and sensible reassurance should be offered to parents. A good clinical assessment, as outlined in this article, will enable Paediatricians with expertise in Cardiology (PECs) and Paediatric Cardiologists (PCs) to safely triage patients and ensure services do not become overwhelmed with demand. This article aims to provide a structured approach to all health professionals who encounter paediatric patients with heart murmurs.
{"title":"Evaluation of heart murmurs in paediatrics: a lost skill in the era of echocardiography?","authors":"Titilayo Ogunlana, Moustafa Eldalal, Paraskevi Mikrou","doi":"10.1016/j.paed.2024.11.003","DOIUrl":"10.1016/j.paed.2024.11.003","url":null,"abstract":"<div><div>Heart murmur is the commonest reason for referral to paediatric cardiology services. Although congenital heart disease (CHD) is common, affecting between 6 and 10 in 1000 live births most heart murmurs are innocent. This is particularly likely in the absence of any cardiac symptoms. When a murmur is heard, it is important to be able to determine which children need urgent assessment by specialist services and which ones can safely wait for a more routine evaluation. Appropriate information and sensible reassurance should be offered to parents. A good clinical assessment, as outlined in this article, will enable Paediatricians with expertise in Cardiology (PECs) and Paediatric Cardiologists (PCs) to safely triage patients and ensure services do not become overwhelmed with demand. This article aims to provide a structured approach to all health professionals who encounter paediatric patients with heart murmurs.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 2","pages":"Pages 53-56"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.paed.2025.01.001
Sarah Reynolds, Owen Bendor-Samuel, Taffy Makaya, Jean Yong, Catherine Quinlan
Neonatal hypercalcemia although often mild and benign has the potential to be a serious condition. There are a wide variety of causes which differ from those seen in children and adults. We present a brief overview of its presentation, common and serious ‘not to be missed’ causes and management. Our aim is to provide a guide of how to approach neonatal hypercalcemia for the paediatrician or other healthcare professional caring for newborn infants.
{"title":"A guide on how to approach neonatal hypercalcemia","authors":"Sarah Reynolds, Owen Bendor-Samuel, Taffy Makaya, Jean Yong, Catherine Quinlan","doi":"10.1016/j.paed.2025.01.001","DOIUrl":"10.1016/j.paed.2025.01.001","url":null,"abstract":"<div><div>Neonatal hypercalcemia although often mild and benign has the potential to be a serious condition. There are a wide variety of causes which differ from those seen in children and adults. We present a brief overview of its presentation, common and serious ‘not to be missed’ causes and management. Our aim is to provide a guide of how to approach neonatal hypercalcemia for the paediatrician or other healthcare professional caring for newborn infants.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 2","pages":"Pages 57-64"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.paed.2024.11.002
Michael Harris
Postural orthostatic tachycardia syndrome (POTS) is a debilitating condition. It is now quite well-known but still poorly understood. The multi-system nature of the condition and the difficulty in treating it adequately are discouraging for health professionals and patients alike. Whilst there is no known associated mortality, it has considerable morbidity. Knowledgeable history taking is essential, diagnostic tests are simple, differential diagnoses are limited. Parental interactions and expectations are key in management. POTS provides an opportunity to combine the science and art of medicine with compassion and empathy. This article outlines a pragmatic approach to understanding, diagnosing and treating this condition. The physiology of standing is discussed, as are some of the putative pathophysiological mechanisms responsible for POTS. The importance of sub-typing POTS as an aid to considered management is explained. Treatment strategies ranging from conservative measures to medications are discussed. Practical, workable tips for managing this condition are provided.
{"title":"A pragmatic approach to paediatric postural orthostatic tachycardia syndrome (POTS)","authors":"Michael Harris","doi":"10.1016/j.paed.2024.11.002","DOIUrl":"10.1016/j.paed.2024.11.002","url":null,"abstract":"<div><div>Postural orthostatic tachycardia syndrome (POTS) is a debilitating condition. It is now quite well-known but still poorly understood. The multi-system nature of the condition and the difficulty in treating it adequately are discouraging for health professionals and patients alike. Whilst there is no known associated mortality, it has considerable morbidity. Knowledgeable history taking is essential, diagnostic tests are simple, differential diagnoses are limited. Parental interactions and expectations are key in management. POTS provides an opportunity to combine the science and art of medicine with compassion and empathy. This article outlines a pragmatic approach to understanding, diagnosing and treating this condition. The physiology of standing is discussed, as are some of the putative pathophysiological mechanisms responsible for POTS. The importance of sub-typing POTS as an aid to considered management is explained. Treatment strategies ranging from conservative measures to medications are discussed. Practical, workable tips for managing this condition are provided.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 2","pages":"Pages 47-52"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.paed.2024.10.001
Sanoj KM Ali, Peter A Dargaville, Samir Gupta
Oxygen is one of the most commonly used therapies in neonatology but the parameters of optimal oxygen for preterm infants have been debated for the past 50 years. The history of oxygen use in this population, as well as the results of clinical trials, have shown that liberal oxygen administration is associated with retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) whereas restrictive use results in increased mortality and neurodisability. Oxygen saturation (SpO2) continuously measured by pulse oximetry is the bedside tool used to guide the fraction of inspired oxygen (FiO2) delivered to preterm infants. Although evidence favours targeting predetermined SpO2 ranges, achieving this goal consistently in clinical practice has been challenging due to intrinsic pulmonary immaturity, the need for respiratory support therapies and factors relating to the bedside caregivers’ ability to adjust FiO2. This review article focuses on the difficulties of titrating oxygen therapy in this vulnerable group and provides recommendations for best practice based on up-to-date evidence.
{"title":"Oxygen therapy in preterm infants: past, present and future","authors":"Sanoj KM Ali, Peter A Dargaville, Samir Gupta","doi":"10.1016/j.paed.2024.10.001","DOIUrl":"10.1016/j.paed.2024.10.001","url":null,"abstract":"<div><div>Oxygen is one of the most commonly used therapies in neonatology but the parameters of optimal oxygen for preterm infants have been debated for the past 50 years. The history of oxygen use in this population, as well as the results of clinical trials, have shown that liberal oxygen administration is associated with retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) whereas restrictive use results in increased mortality and neurodisability. Oxygen saturation (SpO<sub>2</sub>) continuously measured by pulse oximetry is the bedside tool used to guide the fraction of inspired oxygen (FiO<sub>2</sub>) delivered to preterm infants. Although evidence favours targeting predetermined SpO<sub>2</sub> ranges, achieving this goal consistently in clinical practice has been challenging due to intrinsic pulmonary immaturity, the need for respiratory support therapies and factors relating to the bedside caregivers’ ability to adjust FiO<sub>2</sub>. This review article focuses on the difficulties of titrating oxygen therapy in this vulnerable group and provides recommendations for best practice based on up-to-date evidence.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 1","pages":"Pages 1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.paed.2024.10.007
Katrina Roberts, Nicola Goodall
Nightshifts are often unavoidable in the career paths we have chosen as paediatric doctors and whilst we can't pretend it's all fun and games', there is something very satisfying when you get through a set of nights and look back on what you have accomplished with little support in numbers. Here we explore how we, as two paediatric doctors, have developed our own ways of tackling the dark side aiming to keep patient safety a priority and maintaining some sanity. There is now more support than ever to support doctors working nightshifts and we hope to share some tips and resources to make the transition from days to nights a little easier.
{"title":"How to survive and thrive on night shifts","authors":"Katrina Roberts, Nicola Goodall","doi":"10.1016/j.paed.2024.10.007","DOIUrl":"10.1016/j.paed.2024.10.007","url":null,"abstract":"<div><div>Nightshifts are often unavoidable in the career paths we have chosen as paediatric doctors and whilst we can't pretend it's all fun and games', there is something very satisfying when you get through a set of nights and look back on what you have accomplished with little support in numbers. Here we explore how we, as two paediatric doctors, have developed our own ways of tackling the dark side aiming to keep patient safety a priority and maintaining some sanity. There is now more support than ever to support doctors working nightshifts and we hope to share some tips and resources to make the transition from days to nights a little easier.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 1","pages":"Pages 36-39"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.paed.2024.10.006
Sybil Barr
There is increasing interest in the use of probiotics in preterm infants in NICUs to reduce intestinal dysbiosis and subsequently reduce morbidity in these vulnerable neonates. However, heterogenicity of organisms used in various trials has meant definitive evidence is still not available to make strong recommendations and probiotic use remains varied.
{"title":"Probiotics in the NICU: a personal practice","authors":"Sybil Barr","doi":"10.1016/j.paed.2024.10.006","DOIUrl":"10.1016/j.paed.2024.10.006","url":null,"abstract":"<div><div>There is increasing interest in the use of probiotics in preterm infants in NICUs to reduce intestinal dysbiosis and subsequently reduce morbidity in these vulnerable neonates. However, heterogenicity of organisms used in various trials has meant definitive evidence is still not available to make strong recommendations and probiotic use remains varied.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 1","pages":"Pages 34-35"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.paed.2024.10.004
Aravanan Anbu Chakkarapani, S Meghana, Umamaheswari Balakrishnan
Hypoxic-ischemic encephalopathy (HIE) in neonates, particularly near-term and term infants, presents significant risks to survival and neurodevelopmental outcomes. Mild HIE, comprising about 50% of HIE cases, has traditionally been seen as lower risk compared to moderate and severe HIE. However, emerging research suggests that mild HIE can lead to similar adverse outcomes to more severe cases, including brain injury and neurodevelopmental impairment. Therapeutic hypothermia (TH), a proven intervention for moderate to severe HIE, has been largely excluded for mild HIE management due to a lack of robust evidence. This gap has led to a phenomenon known as therapeutic creep, where interventions like TH are extended to milder cases without solid guidelines, raising concerns about its appropriateness and efficacy. This short article discusses the possible limitations of this approach and highlights why evidence from new research is urgently required.
{"title":"Unveiling the hidden risks: therapeutic creep in mild hypoxic ischemic encephalopathy","authors":"Aravanan Anbu Chakkarapani, S Meghana, Umamaheswari Balakrishnan","doi":"10.1016/j.paed.2024.10.004","DOIUrl":"10.1016/j.paed.2024.10.004","url":null,"abstract":"<div><div>Hypoxic-ischemic encephalopathy (HIE) in neonates, particularly near-term and term infants, presents significant risks to survival and neurodevelopmental outcomes. Mild HIE, comprising about 50% of HIE cases, has traditionally been seen as lower risk compared to moderate and severe HIE. However, emerging research suggests that mild HIE can lead to similar adverse outcomes to more severe cases, including brain injury and neurodevelopmental impairment. Therapeutic hypothermia (TH), a proven intervention for moderate to severe HIE, has been largely excluded for mild HIE management due to a lack of robust evidence. This gap has led to a phenomenon known as therapeutic creep, where interventions like TH are extended to milder cases without solid guidelines, raising concerns about its appropriateness and efficacy. This short article discusses the possible limitations of this approach and highlights why evidence from new research is urgently required.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 1","pages":"Pages 23-27"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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