Archives of Disease in Childhood-Education and Practice Edition最新文献

Pertussis (whooping cough) is a bacterial infection caused by the organism Bordetella pertussis It can lead to severe illness and death, especially in neonates and young infants. Pre-vaccination, pertussis was a major contributor to childhood morbidity and mortality. Despite global vaccination programmes, it remains a considerable public health challenge. Infants at high risk of infection presenting with cough and/or apnoea with a peripheral hyperleucocytosis due to lymphocytosis should be investigated and managed with caution. It is important for clinicians to recognise the risk of severe disease in young infants and test symptomatic patients rapidly to guide treatment decisions and inform public health response. The testing of asymptomatic persons or close contacts is not routinely recommended. Antimicrobial treatment, usually an oral macrolide, is recommended for infants, close contacts of symptomatic patients and individuals at risk of severe disease to decrease both severity and the infectious period. Preventative strategies such as immunisation programs encompassing vaccination during each pregnancy, childhood immunisation and considering lifelong additional pertussis vaccine booster doses for adults (especially when in close contact with infants and other vulnerable persons) are important patient-centred public health strategies for clinicians.

Managing a neonate presenting with sudden unexpected postnatal collapse requires the skillset of multiple specialities working together in a stressful situation. Recognition of abnormal neonatal physiology and rapid resuscitation is required for stabilisation. This article aims to provide clinicians with an overview of the key differentials and rationale for initial stabilisation and management strategies. It is relevant to paediatricians as well as clinicians in emergency medicine, anaesthesia and adult critical care who will form the paediatric resuscitation team.

A focused, practical guide for general paediatricians and resident doctors managing neonates with suspected critical congenital heart disease (CHD), a spectrum of life-threatening cardiac defects requiring intervention. Through detailed case examples, we simulate real-world scenarios that highlight the diagnostic challenges and importance of early recognition. The article reviews essential clinical signs-including differential preductal and postductal oxygen saturations, persistent cyanosis unresponsive to oxygen, poor perfusion and weak femoral pulses-that should raise suspicion for critical CHD. It outlines a stepwise approach to initial management, encompassing immediate stabilisation with cautious fluid administration, and the early use of prostaglandin E1 infusions to maintain and increase ductal patency in duct-dependent lesions. Guidance is provided on prostaglandin, escalation, monitoring for side effects and the need for early discussion with tertiary cardiac centres. The article also addresses the careful titration of oxygen therapy to avoid potential risks unique to certain cardiac physiologies. Emphasis is placed on the limitations of prenatal screening programmes and the need for vigilance in postnatal care. Supplementary quiz questions reinforce key learning objectives and ensure knowledge retention. In summary, this article serves as an educational resource for prompt recognition, stabilisation and referral of neonates with critical CHD.