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}
Pub Date : 2025-01-01DOI: 10.1016/j.paed.2024.10.003
Lucy Robertshaw, Stacey Dobbin
A neonatal intensive care unit (NICU) is an area within a hospital designed for newborns and infants born early (before 37 weeks gestation), infants with a low birth weight and/or with a medical condition requiring specialist doctor and nurse care. Approximately 1 in 7 infants require this specialist input. An addition to this, was the evolution of developmental services and neonatal therapists since the 1970s; this was due to the increasing awareness that infants and children may present with developmental challenges and special educational needs following prolonged neonatal intensive care stays. Therefore, developmental care on the NICU needs to be considered as important alongside medical interventions. There is a significant difference between the environment of the NICU and the uterine/womb experience. The role of the neonatal and developmental professionals, alongside the medical staff, such as an occupational therapist (OT) or physiotherapist (PT) is to help bridge this gap by considering and adapting the environment to promote optimal conditions to support brain development, including appropriate sensory and movement experiences, as well as supporting and coaching parents/carers to care for and nurture their newborns’ development from birth.
{"title":"The role of occupational therapy and physiotherapy in the neonatal unit","authors":"Lucy Robertshaw, Stacey Dobbin","doi":"10.1016/j.paed.2024.10.003","DOIUrl":"10.1016/j.paed.2024.10.003","url":null,"abstract":"<div><div>A neonatal intensive care unit (NICU) is an area within a hospital designed for newborns and infants born early (before 37 weeks gestation), infants with a low birth weight and/or with a medical condition requiring specialist doctor and nurse care. Approximately 1 in 7 infants require this specialist input. An addition to this, was the evolution of developmental services and neonatal therapists since the 1970s; this was due to the increasing awareness that infants and children may present with developmental challenges and special educational needs following prolonged neonatal intensive care stays. Therefore, developmental care on the NICU needs to be considered as important alongside medical interventions. There is a significant difference between the environment of the NICU and the uterine/womb experience. The role of the neonatal and developmental professionals, alongside the medical staff, such as an occupational therapist (OT) or physiotherapist (PT) is to help bridge this gap by considering and adapting the environment to promote optimal conditions to support brain development, including appropriate sensory and movement experiences, as well as supporting and coaching parents/carers to care for and nurture their newborns’ development from birth.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 1","pages":"Pages 16-22"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162675","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}
Neonatal seizures are a neurological emergency, particularly prevalent in very low birth weight (VLBW) infants, with incidences ranging from 58/1000 live births in VLBW to 1–3.5/1000 in term infants. These seizures are often linked to hypoxic–ischemic brain injury, intracranial haemorrhage, arterial ischemic stroke, or infection. The diagnosis relies heavily on electroencephalography (EEG) due to the high incidence of electrographic-only seizures. Common aetiologies such as hypoxic ischemic encephalopathy (HIE), hypoglycemia, stroke, and hypocalcemia significantly impact neurodevelopment and seizure recurrence. This short article discusses the causes, diagnosis and management strategies of neonatal seizures, offering practical advice on how to best manage symptomatic and subclinical seizures in babies of various gestation. It highlights the gaps in our knowledge and suggests what further research is essential to refine treatment protocols and improve prognoses for affected neonates.
{"title":"Comprehensive insights into neonatal seizure: etiologies, diagnostic tools, management and future directions","authors":"Aravanan Anbu Chakkarapani, Ishita Singh, Umamaheswari Balakrishnan","doi":"10.1016/j.paed.2024.10.005","DOIUrl":"10.1016/j.paed.2024.10.005","url":null,"abstract":"<div><div>Neonatal seizures are a neurological emergency, particularly prevalent in very low birth weight (VLBW) infants, with incidences ranging from 58/1000 live births in VLBW to 1–3.5/1000 in term infants. These seizures are often linked to hypoxic–ischemic brain injury, intracranial haemorrhage, arterial ischemic stroke, or infection. The diagnosis relies heavily on electroencephalography (EEG) due to the high incidence of electrographic-only seizures. Common aetiologies such as hypoxic ischemic encephalopathy (HIE), hypoglycemia, stroke, and hypocalcemia significantly impact neurodevelopment and seizure recurrence. This short article discusses the causes, diagnosis and management strategies of neonatal seizures, offering practical advice on how to best manage symptomatic and subclinical seizures in babies of various gestation. It highlights the gaps in our knowledge and suggests what further research is essential to refine treatment protocols and improve prognoses for affected neonates.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 1","pages":"Pages 28-33"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162673","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.2024.10.002
Moriam Mustapha, Kim Cahill, Jenifer Moffat, Kate Adele Wilson, Sybil Barr
Optimum nutrition leads to improved long-term neurodevelopmental outcomes in both preterm and term infants admitted to neonatal units (NNUs). This review delineates the phases of nutritional management from full parenteral nutrition, transitioning to enteral nutrition and on to full enteral feeds. It describes the essential components and provides practical tips in the management of nutrition in these infants.
{"title":"Nutrition of preterm and term infants in the neonatal unit","authors":"Moriam Mustapha, Kim Cahill, Jenifer Moffat, Kate Adele Wilson, Sybil Barr","doi":"10.1016/j.paed.2024.10.002","DOIUrl":"10.1016/j.paed.2024.10.002","url":null,"abstract":"<div><div>Optimum nutrition leads to improved long-term neurodevelopmental outcomes in both preterm and term infants admitted to neonatal units (NNUs). This review delineates the phases of nutritional management from full parenteral nutrition, transitioning to enteral nutrition and on to full enteral feeds. It describes the essential components and provides practical tips in the management of nutrition in these infants.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 1","pages":"Pages 8-15"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162676","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 : 2024-10-22DOI: 10.1016/j.paed.2024.09.005
Marianne Leach, Laura Sand, Mel Wood
As the number of children and young people (CYP) attending the emergency department (ED) with a mental health crisis is increasing, it has become evident that neither the environment nor the training for general paediatricians is adequate to meet CYPs’ mental health needs. This short article provides an essential toolkit for paediatricians and other healthcare professionals working with CYP. It provides a resource encompassing skills and knowledge to promote understanding of mental health crises and strategies to address these when CYP are in ED or admitted to the ward. It will allow general paediatricians to address the agitation and distress experienced by many CYP in EDs or on paediatric wards and use verbal de-scalation techniques rather than medications. The toolkit highlights how to take an appropriate mental health history, perform a mental state examination and if necessary medical investigations required, as well as providing an overview of the legal framework under which mental health conditions are managed in different age groups. A short section highlights the most common mental health issues and their management. Lastly, the CAMHS structure is explained to support the multi-professional collaboration needed to ensure CYP are managed appropriately between teams and have the best support and care possible in the ED and on paediatric wards.
{"title":"Children and young people with mental health issues admitted to the hospital: a toolkit for the general paediatrician","authors":"Marianne Leach, Laura Sand, Mel Wood","doi":"10.1016/j.paed.2024.09.005","DOIUrl":"10.1016/j.paed.2024.09.005","url":null,"abstract":"<div><div>As the number of children and young people (CYP) attending the emergency department (ED) with a mental health crisis is increasing, it has become evident that neither the environment nor the training for general paediatricians is adequate to meet CYPs’ mental health needs. This short article provides an essential toolkit for paediatricians and other healthcare professionals working with CYP. It provides a resource encompassing skills and knowledge to promote understanding of mental health crises and strategies to address these when CYP are in ED or admitted to the ward. It will allow general paediatricians to address the agitation and distress experienced by many CYP in EDs or on paediatric wards and use verbal de-scalation techniques rather than medications. The toolkit highlights how to take an appropriate mental health history, perform a mental state examination and if necessary medical investigations required, as well as providing an overview of the legal framework under which mental health conditions are managed in different age groups. A short section highlights the most common mental health issues and their management. Lastly, the CAMHS structure is explained to support the multi-professional collaboration needed to ensure CYP are managed appropriately between teams and have the best support and care possible in the ED and on paediatric wards.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 12","pages":"Pages 444-455"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722149","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 : 2024-10-05DOI: 10.1016/j.paed.2024.09.001
Sofia Manolesou, Marinos Kyriakopoulos
The acute presentation of psychotic symptoms such as hallucinations, delusions and disorganized behavior in a child is a complex and severe clinical problem that requires a prompt response. A thorough assessment of the possible psychiatric and organic causes that can lead to the manifestation of psychosis is necessary; a detailed history and clinical examination will guide further medical investigations. The treatment will be directed by the diagnosis and the underlying cause but acute psychotic symptoms should be targeted without delay. This short article provides background and practical advice for healthcare professionals working with children.
{"title":"Acute-onset psychosis in children and young people","authors":"Sofia Manolesou, Marinos Kyriakopoulos","doi":"10.1016/j.paed.2024.09.001","DOIUrl":"10.1016/j.paed.2024.09.001","url":null,"abstract":"<div><div>The acute presentation of psychotic symptoms such as hallucinations, delusions and disorganized behavior in a child is a complex and severe clinical problem that requires a prompt response. A thorough assessment of the possible psychiatric and organic causes that can lead to the manifestation of psychosis is necessary; a detailed history and clinical examination will guide further medical investigations. The treatment will be directed by the diagnosis and the underlying cause but acute psychotic symptoms should be targeted without delay. This short article provides background and practical advice for healthcare professionals working with children.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 12","pages":"Pages 439-443"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722148","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 : 2024-09-23DOI: 10.1016/j.paed.2024.09.002
Shuang Wang, Lynn Snow
As part of the adoption process in the UK, adoption medical advisors, often community paediatricians, meet prospective adoptive parents to share health information about the child and discuss potential implications for the future. As well as physical health, mental health needs to be addressed especially if there is possible mental illness in the birth parents. However, there is often lack of precise, reliable information available for the birth parents posing a challenge to the counselling process. This article discusses the challenges in addressing the issue of mental health in birth parents and how to approach conversations involving genetic risk when counselling prospective adoptive parents.
{"title":"Counselling prospective adoptive parents about the mental health of birth parents: what does this mean for the child?","authors":"Shuang Wang, Lynn Snow","doi":"10.1016/j.paed.2024.09.002","DOIUrl":"10.1016/j.paed.2024.09.002","url":null,"abstract":"<div><div>As part of the adoption process in the UK, adoption medical advisors, often community paediatricians, meet prospective adoptive parents to share health information about the child and discuss potential implications for the future. As well as physical health, mental health needs to be addressed especially if there is possible mental illness in the birth parents. However, there is often lack of precise, reliable information available for the birth parents posing a challenge to the counselling process. This article discusses the challenges in addressing the issue of mental health in birth parents and how to approach conversations involving genetic risk when counselling prospective adoptive parents.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 12","pages":"Pages 456-460"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722150","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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