Paediatrics and Child Health (United Kingdom)最新文献

Children and young people are at increased risk of heat-related illness such as heat stroke. This is largely due to their anatomy, physiology and overall development. What makes them particularly vulnerable is their reliance on others to protect them from extreme heat and provide shade and water at times of prolonged exposure. With a rise in environmental temperatures associated with global warming, experts are warning of an increase in paediatric heat-related illnesses. Management of heat stroke in adults is well documented, however literature on children and young people is variable. The aim of this paper is to provide an overview of the presentation of paediatric heatstroke for clinicians caring for children and young people.

Abnormalities of the cardiac rhythm are relatively common in children, with an estimated incidence of almost 1 in 4000 births. Most of these are supraventricular, and about half of children will experience their first episode as an infant. Symptoms, particularly in younger children, may be hard to detect. Delay in diagnosis can lead to ventricular dysfunction, heart failure and acute collapse. This short review provides an overview of the types of cardiac arrhythmias commonly encountered in children, provides practical advice for diagnosis, including the utility of different types of cardiac monitoring devices and outlines the management options.

Infective endocarditis is a result of infection of the endocardium, particularly of the heart valves (native or prosthetic valves). The most common causative organisms in the paediatric population are: Streptococci, Staphylococci and Enterococci. The classical signs of infective endocarditis like Roth spots, Janeway lesions, splinter haemorrhages and Osler's nodes are relatively rare in children. A high index of suspicion in a febrile child with a new murmur, detailed history, meticulous examination, repeated blood cultures, and echocardiography are essential in establishing the diagnosis. Management of infective endocarditis involves a prolonged course of antibiotics, at least for 4–6 weeks depending upon the causative organism and underlying heart condition. Complications of infective endocarditis include congestive heart failure resulting from valvular damage/regurgitation, infective emboli leading to abscesses in other organs and abnormal host immunological responses. Prophylactic antibiotics for dental and other medical procedures like genitourinary tract procedures are no longer recommended in the UK. The emphasis should be on educating children and their parents in early recognition of infective endocarditis. Children at high risk of developing endocarditis should be assessed urgently after clinical suspicion.

Kawasaki disease (KD) is a medium vessel vasculitis and is the most common cause of acquired heart disease in childhood. If left untreated, KD leads to coronary artery aneurysms in 15–25% of patients and the mortality rate in the UK is currently 0.4%. As such, KD is an important preventable cause of heart disease in the young. The aetiology of KD remains unknown, but most likely it represents an aberrant inflammatory host response to one or more as yet unidentified immunological trigger(s) in genetically predisposed individuals. The purpose of this article is not to provide an exhaustive review of KD. Rather we provide practical guidance to the clinical approach to refractory KD. Only brief background on the pathogenesis and epidemiology of KD, and emerging newer clinical trials is provided, to place our clinical approach in context.

Rashes in the newborn period often pose a diagnostic puzzle and many healthcare professionals caring for children worry about missing a potentially serious diagnosis. In this short article, we provide some practical advice about how to approach a baby with a rash. We present a systematic approach which will aid diagnosis and management of neonatal dermatological diseases.

Disseminated intravascular coagulation (DIC) is a rare but life-threatening syndrome in children associated with severe disease states and poor outcomes. It is brought about by a complex interplay between the coagulation and inflammatory systems as an endpoint to multiple coagulopathy phenotypes. It has no gold standard test or therapy, making it challenging to diagnose and even harder to treat effectively. Most healthcare professionals working with children will only rarely encounter DIC, but given its significance, it is important to have a reference which makes this entity understandable to those inexperienced in its management. This article reviews DIC for this purpose, aiming to provide a concise and useful tool to help recognise and manage children presenting with DIC. This article also shines a light on what is not known. Much of the paediatric data and recommendations are extrapolated from adult patients which leaves fertile avenues for future research and refinement of practice.

Constipation in children is a common and often difficult-to-treat functional condition. A good understanding of the causes, symptoms, and treatments are important to achieve effective management. This review highlights the pathophysiology of constipation in children and offers practical advice to healthcare professionals caring for children. We focus on possible causes, the importance of good history taking and examination to exclude treatable or causative pathology. The importance of lifestyle choices is discussed as well as guidance on treatment using laxative medication and behavioural modification.

Gastroenteritis is a major cause of mortality worldwide and a common reason for hospitalization in children, with young children, under 5 years of age, being disproportionally affected. This article reviews the burden of acute gastroenteritis, some prevention strategies including rotavirus vaccination, as well as an approach to history, examination and treatment. The text also considers common differential diagnoses for this condition and the use of telephone triage, history and examination to assess the degree of dehydration. Investigations are not usually required but may guide treatment in some circumstances. Oral Rehydration Therapy (ORT) can be used in the majority of cases and approaches to rehydration are detailed. Treatment options including the use of antiemetic treatment and probiotics are outlined. Children with severe dehydration often require IV therapy. The importance of careful sodium monitoring and the risks associated with IV rehydration are also addressed.

Management of paediatric intestinal failure has come a long way since the advent of parenteral nutrition in the 1960s. Our understanding of the normal physiology of the gastrointestinal tract together with deeper understanding about the pathophysiology of some of the conditions that leads to intestinal failure has meant that management is more targeted than previously. This article aims to focus on the application of pathophysiological understanding of intestinal failure in its management and give some direction in managing some common complications intestine failure. It will cover both surgical as well as medical (including dietetic) treatments that can help children with intestinal failure to achieve enteral autonomy.

Intestinal transplantation (ITx) is the only curative treatment option for children with irreversible intestinal failure (IF) and complications of parenteral nutrition (PN). ITx is an immunologically difficult transplant due to the immune load of the donor gut; therefore, main causes of death and graft loss are immunological complications like sepsis or acute and chronic rejection. This article aims to help paediatricians in training understand when children should be referred for ITx, the different types of ITx, the complications these children might present with, and to learn about the journey a candidate for ITx must take with the support of the IF and ITx multidisciplinary teams (MDT).