Pub Date : 2019-08-23DOI: 10.1136/archdischild-2019-317544
M. Blair, E. Wortley, Kirsty McGuff
A large proportion of consultant time is spent in outpatient practice. This setting provides an excellent learning environment for different levels of a trainee if well organised. This article describes an evidence-based teaching approach and its evaluation by trainees, patients and carers in a typical district general hospital setting which it is hoped others might find helpful.
{"title":"Placing education at the centre of the outpatient clinic improves learning and experiences for everyone using the multilevel attainment of learning, teaching and support (MALTS) approach","authors":"M. Blair, E. Wortley, Kirsty McGuff","doi":"10.1136/archdischild-2019-317544","DOIUrl":"https://doi.org/10.1136/archdischild-2019-317544","url":null,"abstract":"A large proportion of consultant time is spent in outpatient practice. This setting provides an excellent learning environment for different levels of a trainee if well organised. This article describes an evidence-based teaching approach and its evaluation by trainees, patients and carers in a typical district general hospital setting which it is hoped others might find helpful.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77531273","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 : 2019-08-23DOI: 10.1136/archdischild-2019-317237
J. Kaufman
Urine samples are commonly collected from young children to diagnose or exclude urinary tract infections, but collection from precontinent children is challenging. Each collection method has advantages and limitations. Non-invasive methods (urine pads, bags, clean catch) are convenient but can be time-consuming and are limited by sample contamination. Voiding stimulation methods (bladder-lumbar stimulation, Quick-Wee) can expedite clean catch collection. Invasive methods (catheter, suprapubic aspiration) can be more reliable, but require expertise to perform and cause pain for the child. This article reviews each collection method, and describes collection procedures, indications and strategies to optimise success and reduce contamination.
{"title":"How to… collect urine samples from young children","authors":"J. Kaufman","doi":"10.1136/archdischild-2019-317237","DOIUrl":"https://doi.org/10.1136/archdischild-2019-317237","url":null,"abstract":"Urine samples are commonly collected from young children to diagnose or exclude urinary tract infections, but collection from precontinent children is challenging. Each collection method has advantages and limitations. Non-invasive methods (urine pads, bags, clean catch) are convenient but can be time-consuming and are limited by sample contamination. Voiding stimulation methods (bladder-lumbar stimulation, Quick-Wee) can expedite clean catch collection. Invasive methods (catheter, suprapubic aspiration) can be more reliable, but require expertise to perform and cause pain for the child. This article reviews each collection method, and describes collection procedures, indications and strategies to optimise success and reduce contamination.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84860628","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 : 2019-08-21DOI: 10.1136/archdischild-2019-317410
Elena Battistuz, L. Travan, J. Bua, A. Trappan, F. Galdo, M. Bobbo, E. Barbi, F. Risso
A 33+1-week female baby was born by caesarean section for worsening hydrops fetalis (HF) detected in the third trimester of pregnancy. Prenatal ultrasound showed a moderate enlargement of the right heart sections with a mild tricuspid insufficiency, without tachycardia, polyhydramnios, placentamegaly, renal agenesis and oesophageal atresia. At delivery, she developed transient hypotonia and apnoea and received nasal continuous positive airway pressure. Physical examination showed tachypnoea (70 breaths/min) and a moderate generalised subcutaneous oedema. Chest X-ray showed a cardiothoracic index of 0.82. At 90 min of life, her heart rate was 200–250 per minute. An ECG showed a paroxysmal supraventricular tachycardia (PSVT) with narrow complexes (figure 1). Vagal manoeuvres and five boluses of adenosine (250 μg/kg/dose) were ineffective, but she responded to amiodarone. Echocardiography showed severe tricuspid insufficiency and dilated right cardiac chambers. The baby presented further transient PSVT episodes, but these gradually improved on amiodarone, hydrochlorothiazide, spironolactone and furosemide. A primitive tricuspid valvulopathy with heart failure secondary to PSVT was diagnosed. …
{"title":"Newborn with hydrops fetalis and a severe supraventricular arrhythmia","authors":"Elena Battistuz, L. Travan, J. Bua, A. Trappan, F. Galdo, M. Bobbo, E. Barbi, F. Risso","doi":"10.1136/archdischild-2019-317410","DOIUrl":"https://doi.org/10.1136/archdischild-2019-317410","url":null,"abstract":"A 33+1-week female baby was born by caesarean section for worsening hydrops fetalis (HF) detected in the third trimester of pregnancy. Prenatal ultrasound showed a moderate enlargement of the right heart sections with a mild tricuspid insufficiency, without tachycardia, polyhydramnios, placentamegaly, renal agenesis and oesophageal atresia. At delivery, she developed transient hypotonia and apnoea and received nasal continuous positive airway pressure. Physical examination showed tachypnoea (70 breaths/min) and a moderate generalised subcutaneous oedema. Chest X-ray showed a cardiothoracic index of 0.82.\u0000\u0000At 90 min of life, her heart rate was 200–250 per minute. An ECG showed a paroxysmal supraventricular tachycardia (PSVT) with narrow complexes (figure 1). Vagal manoeuvres and five boluses of adenosine (250 μg/kg/dose) were ineffective, but she responded to amiodarone. Echocardiography showed severe tricuspid insufficiency and dilated right cardiac chambers. The baby presented further transient PSVT episodes, but these gradually improved on amiodarone, hydrochlorothiazide, spironolactone and furosemide. A primitive tricuspid valvulopathy with heart failure secondary to PSVT was diagnosed. …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75684107","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 : 2019-08-10DOI: 10.1136/archdischild-2019-317052
P. Stilwell, F. Robertson, S. Bhate, A. Sutcliffe
Paediatricians commonly encounter neck lumps during their routine clinical practice; vascular abnormalities, such as (pseudo)aneurysms, are a rare cause of these. Pseudoaneurysms of the carotid artery in children are usually the result of blunt or penetrating trauma, infection or vasculitis/connective tissue disorders. They can present with a variety of symptoms including neck pain, as a pulsatile neck mass or with compressive symptoms (for example, cranial nerve palsies or dyspnoea). Pseudoaneurysms carry a risk of rupture in which case they are fatal, unless immediate treatment is provided. We report a 17-month-old male child with idiopathic carotid artery blowout syndrome presenting with acute oropharyngeal haemorrhage leading to asystolic cardiac arrest. He was successfully resuscitated and emergency embolisation controlled the bleeding. Despite extensive left hemispheric infarct, he has survived. Carotid artery blowout syndrome needs to be recognised as a potential cause of major haemorrhage in childhood. The purpose of this case report is to remind readers of the differential diagnosis and work-up of a child presenting with a neck lump, to highlight important aspects of the acute management of major haemorrhage and massive blood transfusion in paediatrics, to describe the aetiology, presentation and management of carotid artery pseudoaneurysm in children and to discuss long term rehabilitation in patients with consequent neurological sequelae (including the need for input from multiple specialty teams).
{"title":"A child in shock: carotid blowout syndrome","authors":"P. Stilwell, F. Robertson, S. Bhate, A. Sutcliffe","doi":"10.1136/archdischild-2019-317052","DOIUrl":"https://doi.org/10.1136/archdischild-2019-317052","url":null,"abstract":"Paediatricians commonly encounter neck lumps during their routine clinical practice; vascular abnormalities, such as (pseudo)aneurysms, are a rare cause of these. Pseudoaneurysms of the carotid artery in children are usually the result of blunt or penetrating trauma, infection or vasculitis/connective tissue disorders. They can present with a variety of symptoms including neck pain, as a pulsatile neck mass or with compressive symptoms (for example, cranial nerve palsies or dyspnoea). Pseudoaneurysms carry a risk of rupture in which case they are fatal, unless immediate treatment is provided. We report a 17-month-old male child with idiopathic carotid artery blowout syndrome presenting with acute oropharyngeal haemorrhage leading to asystolic cardiac arrest. He was successfully resuscitated and emergency embolisation controlled the bleeding. Despite extensive left hemispheric infarct, he has survived. Carotid artery blowout syndrome needs to be recognised as a potential cause of major haemorrhage in childhood. The purpose of this case report is to remind readers of the differential diagnosis and work-up of a child presenting with a neck lump, to highlight important aspects of the acute management of major haemorrhage and massive blood transfusion in paediatrics, to describe the aetiology, presentation and management of carotid artery pseudoaneurysm in children and to discuss long term rehabilitation in patients with consequent neurological sequelae (including the need for input from multiple specialty teams).","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90968223","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 : 2019-08-10DOI: 10.1136/archdischild-2019-317704
Rachel Toone, C. Harrison
Design: randomised clinical trial.1 Allocation: concealed (web-based randomisation). Blinding: parents, clinicians, investigators and outcome assessors were blinded. Setting : 37 neonatal units in the UK. Patients : infants born before 32 weeks gestation. Exclusion criteria were a severe congenital abnormality, an expected fast of over 14 days or no realistic chance of survival. A total of 2203 babies were enrolled for a target sample size of 2200. Intervention: placebo versus supplementing enteral feeds with 150 mg/kg/day of bovine lactoferrin once the infant was feeding over 12 mL/kg/day. This was continued until 34 weeks corrected gestation. Outcomes: the primary outcome was microbiologically confirmed or clinically suspected late-onset sepsis (LOS) (assessed locally initially, then by a central review committee) from trial entry to hospital discharge. Secondary outcomes were numerous but included necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD), length of stay and mortality predischarge. Composite outcomes were also analysed. Follow-up period: …
{"title":"Enteral lactoferrin supplementation did not reduce the risk of late-onset infection in very preterm infants","authors":"Rachel Toone, C. Harrison","doi":"10.1136/archdischild-2019-317704","DOIUrl":"https://doi.org/10.1136/archdischild-2019-317704","url":null,"abstract":"Design: randomised clinical trial.1 \u0000\u0000Allocation: concealed (web-based randomisation).\u0000\u0000Blinding: parents, clinicians, investigators and outcome assessors were blinded.\u0000\u0000Setting : 37 neonatal units in the UK.\u0000\u0000Patients : infants born before 32 weeks gestation. Exclusion criteria were a severe congenital abnormality, an expected fast of over 14 days or no realistic chance of survival. A total of 2203 babies were enrolled for a target sample size of 2200.\u0000\u0000Intervention: placebo versus supplementing enteral feeds with 150 mg/kg/day of bovine lactoferrin once the infant was feeding over 12 mL/kg/day. This was continued until 34 weeks corrected gestation.\u0000\u0000Outcomes: the primary outcome was microbiologically confirmed or clinically suspected late-onset sepsis (LOS) (assessed locally initially, then by a central review committee) from trial entry to hospital discharge. Secondary outcomes were numerous but included necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD), length of stay and mortality predischarge. Composite outcomes were also analysed.\u0000\u0000Follow-up period: …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75446836","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 : 2019-08-02DOI: 10.1136/archdischild-2019-317817
A. Hopkins, I. Simmons
Objective To provide a systematic approach to the child with a new squint. Method Review of the current available literature. Conclusion Squint is a common presentation in the paediatric population. Although the parents’ primary concern may be cosmetic, a new squint in childhood may be the first sign of a serious or life-threatening ocular or neurological pathology. Thorough assessment and timely referral are essential.
{"title":"Fifteen-minute consultation: Managing a child with a new-onset squint","authors":"A. Hopkins, I. Simmons","doi":"10.1136/archdischild-2019-317817","DOIUrl":"https://doi.org/10.1136/archdischild-2019-317817","url":null,"abstract":"Objective To provide a systematic approach to the child with a new squint. Method Review of the current available literature. Conclusion Squint is a common presentation in the paediatric population. Although the parents’ primary concern may be cosmetic, a new squint in childhood may be the first sign of a serious or life-threatening ocular or neurological pathology. Thorough assessment and timely referral are essential.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77564806","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 : 2019-07-31DOI: 10.1136/archdischild-2019-317833
L. Chapman, A. Friend
Study design : randomised, single-blind trial. Setting: The Netherlands.1 Patients: 94 patients with new-onset (symptom duration <18 months) juvenile idiopathic arthritis (JIA) who had not been exposed to previous disease-modifying antirheumatic drug (DMARD) therapy. Interventions: conventional systemic DMARD monotherapy (methotrexate (MTX) or sulfasalazine) versus MTX plus 6-week tapered course of prednisolone vs MTX plus etarnercept. Outcomes: time to inactive disease; time to flare after the first episode of drug-free inactive disease (DFID). Main results: …
{"title":"Drug-free inactive disease in juvenile idiopathic arthritis can be achieved for 40% of patients","authors":"L. Chapman, A. Friend","doi":"10.1136/archdischild-2019-317833","DOIUrl":"https://doi.org/10.1136/archdischild-2019-317833","url":null,"abstract":"Study design : randomised, single-blind trial.\u0000\u0000Setting: The Netherlands.1 \u0000\u0000Patients: 94 patients with new-onset (symptom duration <18 months) juvenile idiopathic arthritis (JIA) who had not been exposed to previous disease-modifying antirheumatic drug (DMARD) therapy.\u0000\u0000Interventions: conventional systemic DMARD monotherapy (methotrexate (MTX) or sulfasalazine) versus MTX plus 6-week tapered course of prednisolone vs MTX plus etarnercept.\u0000\u0000Outcomes: time to inactive disease; time to flare after the first episode of drug-free inactive disease (DFID).\u0000\u0000Main results: …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77611436","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 : 2019-07-19DOI: 10.1136/archdischild-2019-317811
I. Wacogne
{"title":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2019-317811","DOIUrl":"https://doi.org/10.1136/archdischild-2019-317811","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75873435","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 : 2019-04-29DOI: 10.1136/archdischild-2019-317483
I. Wacogne
{"title":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2019-317483","DOIUrl":"https://doi.org/10.1136/archdischild-2019-317483","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89467322","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 : 2019-03-20DOI: 10.1136/archdischild-2019-317138
I. Wacogne
{"title":"Highlights from this issue","authors":"I. Wacogne","doi":"10.1136/archdischild-2019-317138","DOIUrl":"https://doi.org/10.1136/archdischild-2019-317138","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86731590","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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