MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Archives of Disease in Childhood' source. Thu, 09 Feb 2012 01:09:27 +0100 http://www.medworm.com/index.php?rid=5585740&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F184%3Frss%3D1 Atopic dermatitis (AD) is the most common skin disease of children and is increasing in prevalence worldwide. Skin infection with Staphylococcus aureus is common especially during exacerbations of AD. Infection with group A streptococcus (GAS) is less frequent but also well documented. Workers in San Francisco (Pediatr Dermatol 2011;28:230–4) have compared the clinical features of the two infections. A retrospective study for the period 1999–2001 revealed 245 skin culture results for children with AD, 187 (76%) positive for S aureus or GAS. Among these 187, 143 (76%) grew S aureus alone, 10 (5%) streptococci alone, of which 9 were GAS, and 34 (14%) both S aureus and streptococci, of which 29 were S aureus and GAS). Patients infected with GAS were more likely to have fever, to h... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585740 Wed, 11 Jan 2012 05:00:00 +0100 5585740 http://www.medworm.com/index.php?rid=5585739&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F182-b%3Frss%3D1 Heated humidified high flow nasal cannula (HHHFNC) therapy is becoming increasingly used in preterm infants and there is evidence that it can provide some degree of respiratory support.1 2 We designed a prospective, randomised, open pilot study to assess the safety and feasibility of using HHHFNC therapy in infants with bronchiolitis. We recruited infants with a clinical diagnosis of moderately severe bronchiolitis. Following parental informed consent, infants were randomised to head-box oxygen or the Vapotherm 2000i (Vapotherm Inc, Stevensville, Maryland, USA). Initial vapotherm flow was 4 l/min with 100% oxygen and was increased up to 8 l/min if tolerated. Oxygen concentration was adjusted in both groups to achieve target pulse oximeter oxygen saturation (SpO2) of 92–96%.Vapotherm ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585739 Wed, 11 Jan 2012 05:00:00 +0100 5585739 http://www.medworm.com/index.php?rid=5585738&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F182-a%3Frss%3D1 An important goal of growth monitoring in childhood is to identify genetic disorders and diseases. For early detection one requires adequate growth references, frequent measures of height and weight of children and evidence-based referral criteria. A guideline for short stature was published recently.1 It has been shown that target height (TH) adds greatly to the predictive ability of this guideline. TH is a term used for the expected height of a child given the heights of the parents. The calculation of the TH has changed over the years. In 1886, Galton introduced the mid-parental height (MPH) as the average of the heights of the two parents, that is, MPH=(FH+MH)/2, where FH and MH denote the heights of the father and mother, respectively.2 In 1970, Tanner defined an adjustment for sex on... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585738 Wed, 11 Jan 2012 05:00:00 +0100 5585738 http://www.medworm.com/index.php?rid=5585737&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F181%3Frss%3D1 Given the concerns regarding the routine administration of antipyretics (paracetamol and ibuprofen) in hospitalised children with fever, we recently audited antipyretic prescribing practices at the Royal Children's Hospital Melbourne, Australia (RCH). In this regard, we read with interest the recent editorial by McIntyre on the use of antipyretics in children with fever1 that shares our concerns. As highlighted by McIntyre, there is no evidence that reducing fever in a sick child confers any benefit in reducing mortality. On the contrary, current evidence suggests that reducing fever through the use of antipyretics may in fact adversely affect the outcome following infection.1 In addition, pre-emptive administration of paracetamol prior to vaccination has been associated with reduced antib... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585737 Wed, 11 Jan 2012 05:00:00 +0100 5585737 http://www.medworm.com/index.php?rid=5585736&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F180-b%3Frss%3D1 The British Medical Association toolkit,1 in keeping with government advice, notes that children of 12 years and over are presumed to be competent to provide their consent for the disclosure of their personal information. This is inconsistent with the rules governing the treatment of children in England, Wales and Northern Ireland. The Data Protection Act 1998 noted the presumption (in Scottish law) of competence in children of 12 years or over.2 But the guidance of the Information Commissioner3 on the DPA 1998 and subsequently that of the government4 indicated that the Scottish law applied throughout the entire UK. The Information Commissioner's resultant guidance is clear: ‘that a person of 12 years or more shall be presumed to be of sufficient age and maturity to have...understand... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585736 Wed, 11 Jan 2012 05:00:00 +0100 5585736 http://www.medworm.com/index.php?rid=5585735&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F180-a%3Frss%3D1 Parents' knowledge about the management of fever in children has hardly changed over the past few years in spite of a host of educational interventions aimed at improving awareness of the dangers relating to high fever. Unexpected death in children's febrile diseases is considered to be relatively rare and may mostly occur due to meningitis, bronchiolitis, malaria, acute leukaemia and Kawasaki syndrome. Two rare autosomal recessively inherited diseases can present high fever bouts in the neonatal period, which might represent a serious threat due to their intrinsic risk of unpredictable sudden death: Sohar–Crisponi syndrome (SCS, OMIM 601378) and Stüve–Wiedemann syndrome (SWS, OMIM 601559). SCS is already evident at birth with paroxysmal muscular contractions, resembling n... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585735 Wed, 11 Jan 2012 05:00:00 +0100 5585735 http://www.medworm.com/index.php?rid=5585734&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F177%3Frss%3D1 Scenario An 8-year-old girl attends the accident and emergency department complaining of palpitations and breathlessness for 1 h. An ECG confirms a diagnosis of supraventricular tachycardia (SVT). The patient is haemodynamically stable and vagal manoeuvres are ineffective. Intravenous access is obtained and a 100 µg/kg dose of adenosine is administered with persistence of SVT. A further higher dose of 200 µg/kg is administered with successful restoration of sinus rhythm. The case is discussed with colleagues, who indicate similar initial failures with lower doses of adenosine. You wonder if choosing the higher dose initially would be more effective at re-establishing sinus rhythm? Structured clinical question In children with supraventricular tachycardia [patient], does high do... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585734 Wed, 11 Jan 2012 05:00:00 +0100 5585734 http://www.medworm.com/index.php?rid=5585733&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F175%3Frss%3D1 Scenario The hospital infection control policy suggests that the stethoscope diaphragm should be cleaned before and after each patient contact. You wonder whether regular cleaning of stethoscopes results in a reduction in hospital acquired infections. Structured clinical question In hospital patients [population], does regular cleaning of stethoscopes [intervention] reduce the incidence of nosocomial infection [outcome]? Search strategy and outcome The following resources were searched: Cochrane Library, Trip Database, Medline, PubMed, NHS Evidence and NICE. PubMed search words used were "stethoscope" AND "nosocomial", "hospital acquired", "HAI" AND "infection", "pathogen". No limits were placed on the search. Fourteen of the papers found were relevant and after further review, four were c... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585733 Wed, 11 Jan 2012 05:00:00 +0100 5585733 http://www.medworm.com/index.php?rid=5585732&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F172-b%3Frss%3D1 Scenario You are asked to review a previously healthy 11-month-old boy who presented to the Accident and Emergency department following a generalised convulsion lasting 7 min. His parents tell you that he was started on oral amoxicillin by his general practitioner 2 days ago, the reason for which is unclear. Clinical examination reveals a drowsy child with a temperature of 38.8°C. In the absence of a clear focus of infection you decide to do a full septic screen, including a lumbar puncture (LP). Cerebrospinal fluid (CSF) analysis shows a white blood cell count (WCC) of 17x106/l, a protein concentration within normal limits and no bacteria on a Gram stain. You wonder if the mild CSF pleocytosis indicates partially treated meningitis or can be attributed to the convulsion alone. Structu... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585732 Wed, 11 Jan 2012 05:00:00 +0100 5585732 http://www.medworm.com/index.php?rid=5585731&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F172-a%3Frss%3D1 Archimedes seeks to assist practising clinicians by providing ‘evidence-based’ answers to common questions that are not at the forefront of research but are at the core of practice (format adapted from BestBETS published in the Emergency Medicine Journal). A full description of the format is available online at http://bit.ly/ArchiTemplate. Readers wishing to submit their own questions – with best evidence answers – are encouraged to review those already proposed at http://www.bestbets.org. If your question still hasn't been answered, feel free to submit your summary according to the instructions for authors at http://bit.ly/ArchiInstructions. Slice, dice and eventually something will happen Did you know that aspirin following myocardial infarction (MI) doesn't work ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585731 Wed, 11 Jan 2012 05:00:00 +0100 5585731 http://www.medworm.com/index.php?rid=5585730&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F169%3Frss%3D1 Conclusions Contrary to previous reports, large birth weight was associated with a lower risk for asthma. Instead, a trend towards increased risk of asthma was observed among extremely large-birth-weight infants and interventions to reduce the incidence of extreme large birth weight may help reduce the risk of asthma. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585730 Wed, 11 Jan 2012 05:00:00 +0100 5585730 http://www.medworm.com/index.php?rid=5585729&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F166%3Frss%3D1 Performing a split bilirubin test to identify liver disease in any infant who remains jaundiced beyond 2 weeks of age has been recognised as good clinical practice. The Leeds Community Midwifery Team performed this test, following an agreed protocol, from December 2000. By February 2008, 882 infants had been tested. Three infants were identified as having significant liver disease, including one with biliary atresia. Examining the liver unit database, a further 38 infants with Leeds post codes presented with neonatal liver disease during the study period. Five infants were identified appropriately by the midwives but not reported via the study protocol, 29 were referred from secondary care, (1) by a general practitioner at 9 days of age and (2) who did not become jaundiced before 3 months,... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585729 Wed, 11 Jan 2012 05:00:00 +0100 5585729 http://www.medworm.com/index.php?rid=5585728&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F162%3Frss%3D1 Conclusions The incidence of HSV-induced serious neurological disease in the UK was estimated at 1 in 64 000/year in younger children and 1 in 230 000 in older children. HSV CNS infection has clinical effects ranging from frank encephalitis to severe illness with fever and convulsions to milder disease lacking encephalopathy. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585728 Wed, 11 Jan 2012 05:00:00 +0100 5585728 http://www.medworm.com/index.php?rid=5585727&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F150%3Frss%3D1 Encephalitis is an uncommon but potentially devastating neurological syndrome with different aetiologies including direct central nervous system infection with different agents (most commonly viral) and those mediated by the immune system. Whilst there have been several recent publications and guidelines on the management of bacterial central nervous system infections in adults and children, viral infections have been relatively neglected. Guidelines have been published for adults with encephalitis (www.liv.ac.uk/braininfections) but none exist for children. For these reasons, we have reviewed the literature on encephalitis and have formulated a suggested management strategy for children with suspected, clinically diagnosed and proven encephalitis. We have excluded neonates, as encephaliti... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585727 Wed, 11 Jan 2012 05:00:00 +0100 5585727 http://www.medworm.com/index.php?rid=5585726&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F145%3Frss%3D1 Paediatric intensive care (PIC) services have been centralised to a significant extent in Britain in the past two decades. As part of centralisation, PIC retrieval teams were developed to transport critically ill children from district general hospitals to regional paediatric intensive care units. This review aims to summarise the current state of retrieval in Britain, with reference to the past and possible directions for the future. While significant progress has been achieved, and PIC retrieval has now become a clinical service in its own right, the coming years present unique opportunities as well as challenges for the specialty. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585726 Wed, 11 Jan 2012 05:00:00 +0100 5585726 http://www.medworm.com/index.php?rid=5585725&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F144%3Frss%3D1 Over 780 million people, mostly children in Africa, die of malaria each year. Although malaria control measures such as insecticide-treated bed nets, insecticides and artemisinin-combination treatments, have resulted in reduced malaria morbidity and mortality in some countries, an effective vaccine is badly needed. The RTS,S vaccine targets the circumsporozoite protein. It is given with an adjuvant system (AS01 or AS02) and has shown efficacy in phase 2 trials. Now the initial results of a phase 3 trial in seven countries in subSaharan Africa (The RTS,S Clinical Trials Partnership. New Engl J Med 2011;365:1863–75; see also editorial, ibid: 1926–7) have confirmed that the vaccine is protective. A total of 15460 children in two age groups (6–12 weeks and 5–17 months) ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585725 Wed, 11 Jan 2012 05:00:00 +0100 5585725 http://www.medworm.com/index.php?rid=5585724&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F139%3Frss%3D1 Bradycardia occurs during the intubation of some critically ill children as a result of vagal stimulation due to hypoxia and/or laryngeal stimulation; such ‘stable’ bradycardia is accompanied by selective vasoconstriction. Some induction drugs also induce bradycardia which may be accompanied by vasodilatation which is also a feature of certain pathologies, which influence the progression to ‘unstable’ bradycardia, which does not respond to re-oxygenation and a pause in laryngoscopy. Preintubation atropine diminishes the overall incidence of stable bradycardia during routine anaesthesia. However, clinical studies of critical care intubation show that atropine does not prevent all episodes of bradycardia and specifically cannot affect vasodilatation. As such, there is... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585724 Wed, 11 Jan 2012 05:00:00 +0100 5585724 http://www.medworm.com/index.php?rid=5585723&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F135%3Frss%3D1 This article describes the homeopathic tradition and considers the safety, manufacture, effectiveness and regulation of homeopathic medicines. These medicines are commonly purchased without prescription for children, so an understanding of the basis of therapy is important to ensure appropriate and safe usage. The role of integrated medicine in the National Health Service is also reviewed with identification of research priorities. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585723 Wed, 11 Jan 2012 05:00:00 +0100 5585723 http://www.medworm.com/index.php?rid=5585722&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F129%3Frss%3D1 Achondroplasia, one of the skeletal dysplasias and the commonest form of disproportionate short stature, has a different developmental and growth profile compared to average stature children. In addition, a specific group of complications occur more frequently in children with achondroplasia. These include common but usually relatively minor complications such as recurrent otitis media, and rarer but more severe problems such as cervicomedullary compression. Knowledge of these complications, appropriate surveillance strategies and treatment options is essential for the paediatrician. The authors review the published literature in this area and provide a system based approach to the management of the healthcare needs of the child with achondroplasia. (Source: Archives of Disease in Childhoo... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585722 Wed, 11 Jan 2012 05:00:00 +0100 5585722 http://www.medworm.com/index.php?rid=5585721&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F124%3Frss%3D1 The move from paper to electronic prescribing (EP) and medicine administration systems has long been advocated. Initial studies in the adult setting showed a significant reduction in medication errors. However, there are additional challenges to overcome to tailor these systems to paediatrics. Building on the basic elements of EP with the development of customised paediatric clinical decision support seems to offer the most benefit in terms of error reduction and increasing clinical effectiveness. Continued research is required to optimise these systems and minimise any unintended consequences at all stages of the medication use process. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585721 Wed, 11 Jan 2012 05:00:00 +0100 5585721 http://www.medworm.com/index.php?rid=5585720&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F123%3Frss%3D1 A 12-year-old boy with cerebral palsy had a history of fever, diarrhoea and progressive bilious vomiting for 2 days. Physical examination revealed absent bowel sounds and peritoneal sign. An abdominal plain film showed a ‘V-shaped’ loop of the dilated large intestine with the apex pointing ‘downward’ (figure 1), rather than the typical coffee-bean sign of sigmoid volvulus, which is characterised by an upward-pointing apex. Fluid challenge and broad-spectrum antibiotics were prescribed due to the status of septic shock. Sigmoid volvulus was suspected initially and colonoscopy revealed a transverse colon volvulus about 120 cm from anus. Emergency surgery was arranged due to failed reduction by colonoscopy. Segmental resection of the transverse colon to about 34 cm in ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585720 Wed, 11 Jan 2012 05:00:00 +0100 5585720 http://www.medworm.com/index.php?rid=5585718&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F121%3Frss%3D1 Conclusion Children with tracheostomies can be safely cared for at home, even in a resource-constrained environment, provided training, appropriate technology and social support services are available. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585718 Wed, 11 Jan 2012 05:00:00 +0100 5585718 http://www.medworm.com/index.php?rid=5585717&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F120%3Frss%3D1 Microarray testing (array-based comparative genome hybridisation, aCGH) provides whole genome analysis at a much higher resolution than conventional karyotyping. After routine clinical and laboratory testing with negative results aCGH provides a diagnosis in about 6% of children with non-syndromal global developmental delay (GDD). For selected patients this figure could rise to 11% with low resolution arrays and 16% with high resolution arrays. It has been estimated that aCGH would detect almost all (99%) abnormalities detected by karyotyping in children with GDD. Many clinicians, however, consider a CGH to be too expensive for use as a first line investigation. Now researchers in Canada (Yannis Trakadis, and Michael Shevell. Dev Med Child Neurol 2011;53:994–9 see also commentary, ib... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585717 Wed, 11 Jan 2012 05:00:00 +0100 5585717 http://www.medworm.com/index.php?rid=5585716&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F118%3Frss%3D1 Conclusions Children born late-preterm are less likely to be successful in early school assessments than those born at term. This group of vulnerable children warrants closer surveillance for early identification of potential educational failure. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585716 Wed, 11 Jan 2012 05:00:00 +0100 5585716 http://www.medworm.com/index.php?rid=5585715&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F112%3Frss%3D1 Conclusions Moderate preterm birth affects all domains of behavioural and emotional problems, particularly for girls. MP children should be targeted for the prevention of mental health problems as they have a great impact on developmental and social competencies at school and in the community. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585715 Wed, 11 Jan 2012 05:00:00 +0100 5585715 http://www.medworm.com/index.php?rid=5585714&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F107%3Frss%3D1 Conclusion Cosmopolitan infections are the leading cause of fever in French children returning from tropical and subtropical areas. However, all febrile children who have returned from an endemic area should be tested for malaria. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585714 Wed, 11 Jan 2012 05:00:00 +0100 5585714 http://www.medworm.com/index.php?rid=5585713&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F101%3Frss%3D1 Conclusions Approximately one child in every 18 000 born in Great Britain has CAH. Similar numbers of boys and girls present clinically in the first year of life, but boys present with more severe manifestations, such as salt-wasting crises. Around 70% of newborns who first present with salt-wasting crisis would be detected earlier through newborn screening. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585713 Wed, 11 Jan 2012 05:00:00 +0100 5585713 http://www.medworm.com/index.php?rid=5585712&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F96%3Frss%3D1 Conclusion The magnitude of dehydration in DKA is not reflected by either clinical or biochemical parameters. These findings need confirmation in larger studies. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585712 Wed, 11 Jan 2012 05:00:00 +0100 5585712 http://www.medworm.com/index.php?rid=5585711&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2F93%3Frss%3D1 This article has three main aims: to discuss how paediatricians may come into... (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585711 Wed, 11 Jan 2012 05:00:00 +0100 5585711 http://www.medworm.com/index.php?rid=5585710&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F2%2Fi%3Frss%3D1 Born a bit too early... The long-term problems faced by very preterm survivors have been well documented in this and other journals, but what about the much greater number born between 32 and 36 weeks? Most now have few neonatal problems, and we assume that they will continue to do well, but two papers in this issue challenge that assumption. Potijk et al from the Netherlands used a well-validated tool, the Child Behaviour Checklist, to compare rates of behavioural and emotional problems in children born between 32 and 35 weeks with term controls. They found small but significant differences in a number of areas, with the moderately preterm children reporting more emotional problems and somatising symptoms. They also found some interesting gender differences. Meanwhile, Peacock et al used ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5585710 Wed, 11 Jan 2012 05:00:00 +0100 5585710 http://www.medworm.com/index.php?rid=5496859&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F92%3Frss%3D1 Reference standards for fetal weight and birth weight at various gestational ages are better based on ultrasound estimations of fetal weight than on birth weight because infants born early are more likely to be growth retarded and therefore to skew the percentile charts. Reference standards based on ultrasound estimates of fetal weight may be non-customised, customised (or individualised) by adjusting for ethnic origin, maternal factors such as height and weight, parity and fetal sex, or made country-specific by adjusting for local data, most conveniently average birth weight at term. Non-customised standards are based on women of European stock and individualised standards are based on various ethnic groups in developed countries; neither is applicable to developing countries. Now (Lancet... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496859 Tue, 13 Dec 2011 05:00:00 +0100 5496859 http://www.medworm.com/index.php?rid=5496858&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F91%3Frss%3D1 There has been a major focus on research within the NHS in recent years and many health professionals are now familiar with recruiting patients into clinical trials. The Good Clinical Practiceframework has helped to ensure that this is undertaken in an appropriate manner with careful consideration of the patients' rights. We are involved in an international multicentre study that has a double-blind design. The study involves taking trial drug or placebo for several years and hence represents a significant undertaking for the young person and their family. When planning how to conduct the trial at a local level we decided that we would offer to visit families at home if a person was eligible for inclusion in the study. We expected that the visit would normally take place in the evening when... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496858 Tue, 13 Dec 2011 05:00:00 +0100 5496858 http://www.medworm.com/index.php?rid=5496857&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F90-b%3Frss%3D1 A 1993 survey1 found that, on average, only 2 h was devoted to undergraduate teaching of sleep medicine and that 7% of medical schools undertook no sleep medicine teaching whatsoever. Since the time of publication of this survey, numerous articles have highlighted the effects of sleep-disordered breathing on human disease as well as child development. Examples include the reporting of obstructive sleep apnoea (OSA) as an independent risk factor for adult hypertension2 3 as well as the documentation of the adverse effects of OSA on childhood growth4 and cognitive development.5 6 The aim of our study was to establish whether such knowledge breakthroughs had led to increased teaching within the undergraduate curricula. The 1993 survey of Rosen and colleagues1 was adapted into a semi-structure... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496857 Tue, 13 Dec 2011 05:00:00 +0100 5496857 http://www.medworm.com/index.php?rid=5496856&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F90-a%3Frss%3D1 We examined all the vEEGs that were undertaken in a regional paediatric neurophysiology department in Oxford, following a single unprovoked seizure over a 1-year period (2008–2009), several years after National Institute for Health and Clinical Excellence (NICE)1 guidelines for the management of epilepsy in children became available. Results A total of 998 vEEGs were undertaken during the study period. Of these, 128 were following a first afebrile seizure: 119/128 were referred by general paediatricians and the remaining 9 by paediatric neurologists. The mean age group was 6.5 years (range 1 month to 17 years). Thirty-four of 128 children had an underlying neurodevelopmental problem. In 11 children, there was a family history of epilepsy and in 13... (Source: Archives of Disease in C... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496856 Tue, 13 Dec 2011 05:00:00 +0100 5496856 http://www.medworm.com/index.php?rid=5496855&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F89%3Frss%3D1 We appreciate Bowler and colleagues'1 concerns and recognise that our findings2 are merely exploratory and require replication. We also recognise the sensitivities involved—the individual clinics were not specifically identified because the small number of patients would prevent meaningful deductions, instead we concentrated on the model of care. Nevertheless, individual clinics may feel aggrieved that they are lumped with others. Bowler and colleagues point out potential weaknesses of our study. They rightly highlight the pernicious effect of social deprivation on survival in cystic fibrosis (CF),3 and we were unable to correct for these factors. There are areas of profound deprivation in the areas served by all three models of care and this undoubtedly warrants further exploration.... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496855 Tue, 13 Dec 2011 05:00:00 +0100 5496855 http://www.medworm.com/index.php?rid=5496854&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F88-b%3Frss%3D1 We read with interest the recent paper by Doull et al1 which explores the optimal model for delivery of paediatric cystic fibrosis (CF) care. The authors compared three models of paediatric CF care within their established CF network: full centre care; local clinic based care with annual review by the CF centre; and hybrid care, where a child is usually reviewed at least three times a year by the specialist centre. Three outcomes were considered: nutritional status, pulmonary function and prevalence of chronic Pseudomonas aeruginosa infection. The only significant finding was that the mean forced expiratory volume in one second (FEV1) was lower among children receiving local clinic based care than full centre care (74.5% predicted vs 89.2%; p=0.001), and the authors extrapolate from this t... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496854 Tue, 13 Dec 2011 05:00:00 +0100 5496854 http://www.medworm.com/index.php?rid=5496853&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F88-a%3Frss%3D1 This title1 might suggest primary research but in practice this is a ‘snapshot audit’ of 1 year of data from a wide cross-section of patients receiving three models of care, and although the word does not appear, we have been informed that this study is declared to be an audit. We are consultants from two of the largest cystic fibrosis (CF) clinics in Wales. We were provided with a draft of the paper but declined to be listed as contributors after pointing out its flaws, as have been highlighted by others.2 Since we do not agree with its conclusions, we had requested of the Archives of Disease in Childhood that any reference to a ‘South Wales CF Network’ should not appear. The description of the models of care is disingenuous: the authors allude to ‘specialist... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496853 Tue, 13 Dec 2011 05:00:00 +0100 5496853 http://www.medworm.com/index.php?rid=5496852&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F87%3Frss%3D1 Chronic granulomatous disease (CGD) is a rare primary immunodeficiency, characterised by life-threatening bacterial and fungal infections and inflammatory complications.1 Cognitive difficulties are also described.2 Chronic ill health and cognitive difficulties potentially expose patients to psychological difficulties. We analysed data in a national cohort of patients with CGD to understand how these difficulties might manifest. Physicians enrolled patients in the national CGD registry between 2000 and 2001.1 Clinical data were gathered from medical records. Parents of children aged 5–15 years and children aged 11 years and above completed the Strengths and Difficulties Questionnaire (SDQ). Mean SDQ scores for the five domains were compared with the UK population norms.3 Scores were a... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496852 Tue, 13 Dec 2011 05:00:00 +0100 5496852 http://www.medworm.com/index.php?rid=5496851&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F84%3Frss%3D1 This article, which follows a debate between the authors on the topic at the 2010 Royal College of Paediatrics and Child Health Annual meeting, discusses the differential diagnoses of a young child presenting with the so-called toddler diarrhoea. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496851 Tue, 13 Dec 2011 05:00:00 +0100 5496851 http://www.medworm.com/index.php?rid=5496850&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F78%3Frss%3D1 Up to 25% of patients with Crohn's disease and ulcerative colitis present before the age of 18 years. Although the pathophysiology of inflammatory bowel disease presenting in childhood does not differ fundamentally from that presenting in adulthood, managing these younger patients requires special consideration in light of growth and the potential long term consequences of both the disease and its treatments. Therapeutic approaches have changed in recent years, and there is a fuller appreciation of the role (and risks) of anti-tumour necrosis factor monoclonal therapy. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496850 Tue, 13 Dec 2011 05:00:00 +0100 5496850 http://www.medworm.com/index.php?rid=5496849&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F73%3Frss%3D1 Child health surveillance (CHS) has evolved greatly over the past 30 years from a proactive screening process by health professionals to a more passive approach of child health promotion (CHP), which places the main responsibility for detection of developmental problems on carers. The impetus for this change came from the Hall Report (1989), which reported a lack of evidence for CHS. Although research on developmental screening is sparse, some data show that use of structured methods for identifying deviations from normal increases the pick-up rate of abnormalities, compared with informal or parent-initiated methods. The majority of countries recommend a universal ‘CHS’ type of programme, in contrast to the UK and some other European countries. Alternatives to universal CHS inc... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496849 Tue, 13 Dec 2011 05:00:00 +0100 5496849 http://www.medworm.com/index.php?rid=5496848&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F69%3Frss%3D1 This article discusses recent advances in the understanding of their aetiology and classification together with the place of newer modalites of surgical treatment such as laparoscopic excision and biliary reconstruction. Although these are definitely feasible and safe, care should be taken before dispensing with standard open techniques which have minimal complications and proven long-term benefit. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496848 Tue, 13 Dec 2011 05:00:00 +0100 5496848 http://www.medworm.com/index.php?rid=5496847&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F63%3Frss%3D1 Growth hormone (GH) therapy has now been available for over 5 decades, with all GH now biosynthetically produced, and administered by daily injection. Paediatric GH is currently licensed in six different conditions: growth hormone deficiency (GHD), Turner syndrome (TS), small for gestational age (SGA), Prader-Willi-syndrome (PWS), chronic renal insufficiency (CRI), and short stature due to SHOX deficiency; all of these have been ratified by the most recent (2010) NICE review. Whilst the primary purpose of paediatric GH therapy in most indications is to improve short and long-term growth, in others (eg. PWS) it has a role in improvement of body composition. Recent UK national audits indicate approximately 4700 children receiving GH therapy, with approximately 760 new starts a year, with mos... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496847 Tue, 13 Dec 2011 05:00:00 +0100 5496847 http://www.medworm.com/index.php?rid=5496846&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F59%3Frss%3D1 Summary Armed conflict has a major impact on child health throughout the world. One in six children worldwide lives in an area of armed conflict and civilians are more likely to die than soldiers as a result of the conflict. In stark contrast to the effect on children, the international arms trade results in huge profits for the large corporations involved in producing arms, weapons and munitions. Armed conflict is not inevitable but is an important health issue that should be prevented. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496846 Tue, 13 Dec 2011 05:00:00 +0100 5496846 http://www.medworm.com/index.php?rid=5496845&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F54%3Frss%3D1 Sleep is essential, but poses a risk to breathing in some children. We have outlined the developmental changes in sleep patterns and physiology, and the evidence of deleterious effects of sleep deprivation and of sleep-related breathing disorder (SRBD). Some factors increase the risk of adenotonsillar surgery and should be excluded before contemplating surgery in a secondary care setting. Screening for SRBD is indicated in some conditions, which are discussed. Although simple studies may suffice for many patients, there are a few who need more detailed assessment with polysomnography. A managed clinical network would be the most appropriate model to ensure appropriate organisation and utilisation of scarce resources in this area. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496845 Tue, 13 Dec 2011 05:00:00 +0100 5496845 http://www.medworm.com/index.php?rid=5496844&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F52%3Frss%3D1 The frequency, cause and treatment of limb pain were ascertained in a cohort of children at six time points between the ages of 5 and 13 years. Data were collected using self-completion questionnaires sent to the chief carers of children in the Avon Longitudinal Study of Parents and Children. Reports of limb pain over the study period doubled from 15.1% of children aged 5 to 32.5% aged 13; 3.4% of children had limb pain at all time points, 43.4% never reported limb pain and 56.6% reported limb pain on at least one occasion. Growing pains were the most common ‘cause’ given for limb pains. Limb pain and growing pains were each associated with a family history of arthritis and rheumatism. Limb pain prevalence may have been under-reported in this study due to gradual attrition, par... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496844 Tue, 13 Dec 2011 05:00:00 +0100 5496844 http://www.medworm.com/index.php?rid=5496843&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F49%3Frss%3D1 Conclusions Children with SLI are more likely to have a small HC at birth but not at 18 weeks gestation or infancy, suggesting growth asynchrony in brain development during the second half of pregnancy. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496843 Tue, 13 Dec 2011 05:00:00 +0100 5496843 http://www.medworm.com/index.php?rid=5496842&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F46%3Frss%3D1 Children treated for acute leukaemia are at increased risk of infection with Streptococcus pneumoniae. The basis for this may include low levels of pneumococcal antibody but this has not been well studied. The authors measured serotype-specific pneumococcal IgG antibody concentrations in children treated for acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) ≥6 months after completion of standard-dose chemotherapy. Pneumococcal serotype-specific IgG antibody concentrations were low. None of the subjects had protective concentrations against all the heptavalent-pneumococcal conjugate vaccine serotypes. There was no significant difference in antibody concentrations between subjects with ALL and AML (p≥0.05). Children treated for ALL and AML generally have non-protect... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496842 Tue, 13 Dec 2011 05:00:00 +0100 5496842 http://www.medworm.com/index.php?rid=5496841&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F43%3Frss%3D1 In conclusion, chronic constipation is a significant problem affecting 15% of Sri Lankan school children and adolescents. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496841 Tue, 13 Dec 2011 05:00:00 +0100 5496841 http://www.medworm.com/index.php?rid=5496840&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F39%3Frss%3D1 Conclusions Informal childcare was associated with a reduced likelihood of breastfeeding for all groups of mothers. Formal childcare arrangements were only associated with a reduced likelihood of breastfeeding if used full-time by more advantaged families. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496840 Tue, 13 Dec 2011 05:00:00 +0100 5496840 http://www.medworm.com/index.php?rid=5496839&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F35%3Frss%3D1 Every year, over 875 000 children between 0 and 18 years of age die as a result of unintentional injuries (UIs), with a higher proportion occurring in low- and middle-income countries (LMICs): the WHO 2008 World Report on Child Injury Prevention shows a child UI death rate 3.4 times greater in LMICs than in high income countries (HICs) (41.7 per million vs 12.2 per million, respectively). Deaths due to injuries from drowning, burns and falls are significantly higher among LMICs at 7.8, 4.3 and 2.1 per million, respectively, as compared to HICs with 1.2, 0.4 and 0.4 per million, respectively. The authors present a review of childhood UIs in LMICs undertaken to determine demographic and socioeconomic risk factors. As in industrialised settings, age, gender and social deprivation are signific... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496839 Tue, 13 Dec 2011 05:00:00 +0100 5496839 http://www.medworm.com/index.php?rid=5496838&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F34%3Frss%3D1 A 2-month-old girl with bladder extrophy had undergone multiple pelvic surgeries since birth. Persistent right lung opacity was noted on serial chest radiographs, which were performed as a part of continued recovery from pelvic surgery. No specific signs or symptoms of respiratory distress were present. Apart from the bladder extrophy, other congenital malformations, such as horse-shoe kidneys and hemivertebrae, were also present. Chest radiograph (figure 1A) shows right lower lobe opacity, which contains linear lucencies, suggestive of air filled bronchi. The presence of vertebral and kidney anomalies did raise concern for a possible tracheal/oesophageal malformation. Hence, an oesophagram was performed. The oesophagram (figure 1B) demonstrates communication of the right lower lobe with t... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496838 Tue, 13 Dec 2011 05:00:00 +0100 5496838 http://www.medworm.com/index.php?rid=5496837&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F33%3Frss%3D1 Neonatal infection with herpes simplex virus (HSV) presents in various ways with varying outcomes. It may be fairly benign with skin, eye and mouth involvement only, no risk of death, and a very low risk of neurological impairment although there may be skin recurrences. Disseminated disease, however, is associated with a 30% mortality and a 20% risk of neurological sequelae among survivors. Central nervous system (CNS) infection is associated with a 6% mortality but a 70% risk of permanent neurological sequelae. The virus may become latent in sensory ganglia with later reactivation and it has been suggested that there may be subclinical reactivation within the brain. The value of 6 months of suppressive oral therapy with acyclovir, after initial parenteral treatment, has been assessed in t... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496837 Tue, 13 Dec 2011 05:00:00 +0100 5496837 http://www.medworm.com/index.php?rid=5496836&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F31%3Frss%3D1 Conclusions Despite the successful implementation of newborn hearing screening, clinical pathways with access to audiological assessment need to be maintained within a universal Healthy Child Programme. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496836 Tue, 13 Dec 2011 05:00:00 +0100 5496836 http://www.medworm.com/index.php?rid=5496835&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F28%3Frss%3D1 Conclusion This study confirms an increased occurrence of spontaneous tinnitus in children with TTS or HI and in children with both TTS and HI, in particular, but also in children with normal hearing. Possibly, tinnitus in young children correlates with stress as in adolescents and adults. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496835 Tue, 13 Dec 2011 05:00:00 +0100 5496835 http://www.medworm.com/index.php?rid=5496834&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F21%3Frss%3D1 Conclusions Young children with community-acquired pneumonia may not receive an antibiotic before hospital admission because the illness evolves rapidly or the prescribed medicine is not given by parents. However, missed opportunities for appropriate antibiotic prescribing by health professionals in primary care appear to be common. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496834 Tue, 13 Dec 2011 05:00:00 +0100 5496834 http://www.medworm.com/index.php?rid=5496833&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F17%3Frss%3D1 Conclusions These differences in pulmonary function are likely to reflect the model of care received, and may affect long term outcomes. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496833 Tue, 13 Dec 2011 05:00:00 +0100 5496833 http://www.medworm.com/index.php?rid=5496832&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F12%3Frss%3D1 Conclusions CD affected 1% of these New Zealand children, but 5% reported gluten avoidance. The predictors of gluten avoidance in children without doctor-diagnosed CD suggest important regional differences in community belief or medical practice regarding implementation of gluten avoidance and the contributory role of non-specific subjective abdominal complaints. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496832 Tue, 13 Dec 2011 05:00:00 +0100 5496832 http://www.medworm.com/index.php?rid=5496831&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F11%3Frss%3D1 A programme to improve the management of children with cerebral palsy and to monitor their progress was introduced in two southern counties in Sweden in 1994. Since then it has been extended to the whole country, and has been taken up by Norway, Denmark and Iceland, and become well-known globally. Data on survival to late adolescence and on causes of death and associated factors have been reported (Lena Westbom and colleagues. Dev Med Child Neurol 2011;53:808–14; see also Commentary, ibid: 776). The study included 708 of 718 children with cerebral palsy who survived to the age of 2 years and had been born in the two southernmost counties of Sweden between 1990 and 2005 or had lived there at any time between 1990 and January 2010. Follow-up was to the end of January 2010. All of the c... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496831 Tue, 13 Dec 2011 05:00:00 +0100 5496831 http://www.medworm.com/index.php?rid=5496830&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F8%3Frss%3D1 Conclusion The current UK practice has shown a continued reduction in the number of children receiving treatment in comparison with historical data and international practice. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496830 Tue, 13 Dec 2011 05:00:00 +0100 5496830 http://www.medworm.com/index.php?rid=5496829&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F5%3Frss%3D1 Introduction Inflammatory bowel disease (IBD) is a chronic relapsing and remitting disease that is increasing in incidence throughout the Western world.1 Although multiple questions regarding its aetiology remain, immunosuppressive therapy is used as the mainstream treatment in both adults and children.2 Concerns have been raised regarding theirsafety and potential side effects on a short-term and long-term basis. Several databases have been initiated to evaluate this effect. Based on recent reports of an increased incidence of hepatosplenic T cell lymphoma in young male IBD patients receiving a combination therapy of anti-tumour necrosis factor antibodies and azathioprine (Aza), malignancy is the most dreaded complication.3 Nevertheless, as in all immunosuppressed patients, opportunistic ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496829 Tue, 13 Dec 2011 05:00:00 +0100 5496829 http://www.medworm.com/index.php?rid=5496828&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2F1%3Frss%3D1 Introduction Routine medical care involving blood sampling and other potentially painful procedures can lead to considerable distress for children and their carers. It is important that these should be undertaken with as little pain as possible. Yet despite the availability of effective topical and systemic analgesic agents, children and young people continue to find such procedures, particularly those involving needles, one of the most frightening aspects of attending primary and secondary healthcare services.1 While many cope, many do not; giving rise to a range of negative emotional and behavioural consequences, fear and pain. Some children and young people exhibit such distress that the process becomes fraught and eventually abandoned, or they are restrained, intensifying the anguish f... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496828 Tue, 13 Dec 2011 05:00:00 +0100 5496828 http://www.medworm.com/index.php?rid=5496827&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F97%2F1%2Fi%3Frss%3D1 Skinning cats for a living Let's kick off with an aphorism fit for this most ascetic of months. The scholar who cherishes the love of comfort is not fit to be deemed a scholar (Confucius c 500 BC). Surely, ‘the love of comfort’ Confucius alludes to is dogma. I’m allergic to the ‘it must be so’ school of thought (more on IgE-related matters later), which plagues medicine as much as any other walk of life. How refreshing, therefore, to introduce a crop of papers that either challenge dogma or chronicle its demise. Idiopathic thrombocytopenic purpura Little more than 20 years ago, any child with, even mild, idiopathic thrombocytopenic purpura (ITP) would have been subjected to not only invasive investigation (a bone marrow aspiration at least) but also to a prolo... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5496827 Tue, 13 Dec 2011 05:00:00 +0100 5496827 http://www.medworm.com/index.php?rid=5402100&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1208%3Frss%3D1 Between 6% and 20% of women of reproductive age have thyroid autoantibodies and there is evidence that this increases the risk of spontaneous abortion or preterm birth. A meta-analysis of published evidence (BMJ 2011;342: d2616; see also editorial, ibid: d 2260) has confirmed the increased risks and suggested that treatment with levothyroxine may reduce them. The meta-analysis included 31 studies (19 cohort, 12 case-control, 1216 women) about spontaneous abortion and five cohort studies (12566 women) about preterm birth, all including women with thyroid autoantibodies and apparently normal thyroid function. The presence of thyroid autoantibodies increased the risk of spontaneous abortion 3.9-fold in cohort studies and 1.8-fold in case-control studies. Among women with thyroid autoantibodie... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402100 Fri, 11 Nov 2011 05:00:00 +0100 5402100 http://www.medworm.com/index.php?rid=5402099&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1207%3Frss%3D1 This article has been selected for FNN and will be published in a forthcoming issue. The paper will be available to view on the Fetal and Neonatal Medicine Online First page. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402099 Fri, 11 Nov 2011 05:00:00 +0100 5402099 http://www.medworm.com/index.php?rid=5402098&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1206-b%3Frss%3D1 Recent reductions in working hours and the increasing complexity of care in the UK both demand an increase in the number of consultant paediatricians.1 Responses of UK medical school graduates from 1974 to 2002 when surveyed on career influences indicate the importance of experiencing paediatrics during both medical school and the early postgraduate years.2 Recruitment into paediatrics should therefore begin in medical school, giving students early exposure to the best that paediatrics has to offer, especially as this may be their only opportunity before choosing careers.3 It is at this critical point that student-led paediatric societies could play a vital role. The Cambridge University Paediatric Society (CUPS) was established in 2009 to increase medical student exposure to paediatrics. ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402098 Fri, 11 Nov 2011 05:00:00 +0100 5402098 http://www.medworm.com/index.php?rid=5402097&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1206-a%3Frss%3D1 Background Anecdotal reports in neonatal intensive care units (NICUs) suggest changes in naming patterns towards the more esoteric. This overdue time trend analysis looks at admission names from 3 years in a busy Southern England tertiary NICU. There is evidence of potential harm (educational and societal) related to unusual names. Objective To test the hypothesis that NICU babies' naming practices have veered from the norm in 25 years. Methods Children's names were divided into quintiles ranked by popularity: names 1st–5th most popular (A), 6th–10th (B), 11th–20th (C), 20th–40th (D) and 41st onwards (E). Using the ONS registry of UK births1 we derived expected frequencies for each quintile. Names were extracted from ward admission books for 3 months from 1987, 1996... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402097 Fri, 11 Nov 2011 05:00:00 +0100 5402097 http://www.medworm.com/index.php?rid=5402096&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1203%3Frss%3D1 Scenario A 3-week-old baby presents with cough and episodes of apnoea. Nasopharyngeal aspirate is negative for common respiratory viruses. You consider the diagnosis of pertussis and take a full blood count to assess the lymphocyte count. You wonder what the sensitivity and specificity of the lymphocyte count is for pertussis in infants. Structured clinical question In an infant with clinical suspicion of pertussis [patient], how useful is a lymphocyte count [intervention] to determine the likelihood of a positive or negative diagnosis [outcome]? Search strategySecondary sources A search of The Cochrane Library using the search term "pertussis" yielded five reviews, none of which were relevant. Primary sources A Medline search was performed using the following terms: (MeSH: Lymphocytosis O... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402096 Fri, 11 Nov 2011 05:00:00 +0100 5402096 http://www.medworm.com/index.php?rid=5402095&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1201%3Frss%3D1 Scenario The Pedi-Cap device (Covidien, Mansfield, Massachusetts, USA) is frequently used in neonatal resuscitation to check the position of the endotracheal (ET) tube in term and preterm neonates. As a paediatric trainee having worked in various regions of the UK you note a huge variability in this practice. Clinical assessment of chest expansion and air entry, with improvement in saturations, colour and heart rate have been used for decades and work well. Is the Pedi-Cap superior to clinical assessment for checking the position of the ET tube? Structured clinical question During intubation of neonates [patients], is a carbon dioxide detector [intervention] better than clinical assessment [comparison] to detect correct endotracheal tube placement [outcome]? Search strategy and outcome Med... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402095 Fri, 11 Nov 2011 05:00:00 +0100 5402095 http://www.medworm.com/index.php?rid=5402094&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1199-b%3Frss%3D1 Scenario A premature infant (30 weeks) weighing 1050g was recently admitted to the neonatal intensive care unit after an uncomplicated delivery. You have spoken to the mother regarding the benefits of expressed breast milk (EBM) compared to premature formula milk, including the decreased risk of necrotising enterocolitis (NEC), and this is being administered via a nasogastric tube. At the ward round the consultant suggests the addition of EBM fortifier to ensure the baby has an adequate intake of macronutrients and micronutrients and to maximise extra-uterine growth. You wonder if the addition of a cow's milk-based fortifier to EBM will confer an increased risk of NEC and decide to find out more. Structured clinical question In premature infants (<37 weeks) [patient] does supplementatio... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402094 Fri, 11 Nov 2011 05:00:00 +0100 5402094 http://www.medworm.com/index.php?rid=5402093&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1199-a%3Frss%3D1 Archimedes seeks to assist practising clinicians by providing ‘evidence-based’ answers to common questions that are not at the forefront of research but are at the core of practice (format adapted from BestBETS published in the Emergency Medicine Journal). A full description of the format is available online at http://bit.ly/ArchiTemplate. Readers wishing to submit their own questions – with best evidence answers – are encouraged to review those already proposed at http://www.bestbets.org. If your question still hasn't been answered, feel free to submit your summary according to the instructions for authors at http://bit.ly/ArchiInstructions. Confident in predicting? Meta-analysis models, step two So, in a previous column1 I made a foray into the dangerous world of ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402093 Fri, 11 Nov 2011 05:00:00 +0100 5402093 http://www.medworm.com/index.php?rid=5402092&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1195%3Frss%3D1 Conclusions Children referred to palliative care services at discharge from PICU are more likely to die in the community (home or hospice) than children not referred to palliative care. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402092 Fri, 11 Nov 2011 05:00:00 +0100 5402092 http://www.medworm.com/index.php?rid=5402091&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1191%3Frss%3D1 Conclusions This short e-learning resource significantly improved the paediatric prescribing skills of junior doctors. Outcomes were maintained at 3 months, suggesting the utility of low cost, low fidelity, educationally sound e-learning interventions. However, the direct impact on patient outcomes following this intervention has yet to be determined. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402091 Fri, 11 Nov 2011 05:00:00 +0100 5402091 http://www.medworm.com/index.php?rid=5402090&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1187%3Frss%3D1 Conclusion Weight can be estimated accurately enough to calculate antipyretic medicine doses by the minority of parents having scales that can be used to estimate their child's weight. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402090 Fri, 11 Nov 2011 05:00:00 +0100 5402090 http://www.medworm.com/index.php?rid=5402089&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1180%3Frss%3D1 Conclusion Drug treatment for LCOS in children with OHS across Europe is highly variable, possibly partly reflecting the lack of evidence and prescribing standards on the use of medicines. Milrinone, epinephrine, dopamine and dobutamine are mostly used, and should be prioritised for future research on LCOS treatment. Such research should be aimed at increasing the level of evidence for clinical practice guidelines to improve the standard of care. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402089 Fri, 11 Nov 2011 05:00:00 +0100 5402089 http://www.medworm.com/index.php?rid=5402088&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1175%3Frss%3D1 Conclusions There is little evidence of any benefit or harm from the combined treatment compared with the use of each drug alone. In the absence of such benefit, there is little to recommend the unnecessary use of polypharmaceutical methods to treat a symptom that does not require treatment, when effective monotherapies exist. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402088 Fri, 11 Nov 2011 05:00:00 +0100 5402088 http://www.medworm.com/index.php?rid=5402087&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1173%3Frss%3D1 Fever is a common symptom in children and probably the most common reason for a child to be taken to the doctor.1 It is a cause of anxiety for carers, bringing to the surface many fears, most of which are unfounded.2–5 The reaction of the health professional may reinforce these concerns, particularly if the nature of fever and its significance is not properly communicated and fever is managed as an illness rather than a symptom.3 Antipyretic use is widespread both in prehospital and hospital settings. When temperature reduction is seen as the end point, it is not surprising that various drugs and combinations of drugs have been used. The systematic review of studies comparing combined treatment of the commonly used antipyretics—paracetamol and ibuprofen—concludes that the... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402087 Fri, 11 Nov 2011 05:00:00 +0100 5402087 http://www.medworm.com/index.php?rid=5402086&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1172%3Frss%3D1 The reported prevalence of sleep disorders among children with autistic spectrum disorders (ASD) is between 40% and 86%. The sleep disorders include taking longer to fall asleep (longer sleep onset latency), frequent waking during the night and shorter sleep. There may be associated mood disorders and other problems such as gastrointestinal disorders. It has been suggested that abnormal melatonin secretion might be involved in the development of ASD and that treatment with melatonin might be beneficial. A systematic review and meta-analysis (Daniel A Rossignol and Richard E Frye. Dev Med Child Neurol 2011;53:783–92) has collated the evidence. Nine studies reported plasma or urine concentrations of melatonin or melatonin metabolites in ASD and all reported abnormalities. Seven of thes... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402086 Fri, 11 Nov 2011 05:00:00 +0100 5402086 http://www.medworm.com/index.php?rid=5402085&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1167%3Frss%3D1 Summary ‘Liberating the NHS’ and the new outcomes framework place information at the heart of the management of the National Health Service (NHS) and develop further the quality framework defined by Lord Darzi. In support of children, paediatricians have a responsibility to understand the informatics agenda and to ensure that data collection is as accurate as possible. There are particular difficulties in supplying a comprehensive health record for children and providing them with the benefits of access to their health records. It is essential that paediatricians work to ensure that these problems are overcome and that children do not miss out because of legal, practical and ethical issues which can be overcome, but often are permitted to stand in the way of real improvements. ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402085 Fri, 11 Nov 2011 05:00:00 +0100 5402085 http://www.medworm.com/index.php?rid=5402084&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1166%3Frss%3D1 A previously healthy 13-year-old boy presented with left arm and face weakness. Brain MRI (figure 1, axial T1 postcontrast) revealed an enhancing mass within the right centrum semiovale, and a second non-enhancing lesion in the left occipital region (not shown). Lumbar puncture revealed five oligoclonal bands, giving a working diagnosis of a demyelinating disorder. Intravenous methylprednisolone was given, and his symptoms nearly resolved. Within days, he returned with complete left arm and leg hemiparesis. Repeat MRI (figure 2, axial T1 postcontrast) revealed a lesion with concentric rings and peripheral enhancement. Based on his clinical picture, oligoclonal bands in the cerebrospinal fluid and characteristic imaging findings, a diagnosis of Balós concentric sclerosis was given. B... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402084 Fri, 11 Nov 2011 05:00:00 +0100 5402084 http://www.medworm.com/index.php?rid=5402083&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1162%3Frss%3D1 Postindustrial human activity has contributed to rising atmospheric levels of greenhouse gases causing global warming and climate change. The adverse effects of climate change affect children disproportionately, especially in the developing world. Urgent action is necessary to mitigate the causes and adapt to the negative effects of climate change. Paediatricians have an important role in managing the effects of climate change on children and promoting sustainable development. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402083 Fri, 11 Nov 2011 05:00:00 +0100 5402083 http://www.medworm.com/index.php?rid=5402082&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1156%3Frss%3D1 Silver–Russell syndrome (SRS) is characterised by intrauterine growth restriction, poor postnatal growth, relative macrocephaly, triangular face, asymmetry and feeding difficulties. As many of these features are non-specific, clinical diagnosis of SRS remains difficult. Hypomethylation of the imprinting control region (ICR) 1 on chromosome 11p15 and maternal uniparental disomy (mUPD) for chromosome 7 are found in up to 60% and around 5–10% of patients with SRS, respectively. Patients with ICR1 hypomethylation are more likely to have classical features of SRS, including asymmetry; patients with mUPD7 are more likely to have learning difficulties, particularly speech problems, although these are usually mild. As features vary widely in severity, clinicians should have a low thres... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402082 Fri, 11 Nov 2011 05:00:00 +0100 5402082 http://www.medworm.com/index.php?rid=5402081&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1147%3Frss%3D1 Introduction In recent years significant technical and clinical advances have resulted in the recognition of cardiovascular magnetic resonance (CMR) as a valuable tool for the comprehensive evaluation of diseases of the cardiovascular system in childhood. In contrast to echocardiography CMR is not limited by acoustic windows. It is non-invasive and avoids the use of ionising radiation and iodinated contrast when compared with invasive angiography. In current clinical practice, CMR is increasingly used in concert with other imaging modalities to provide high-resolution three-dimensional (3D) imaging of complex anatomy, accurate quantitative assessment of physiology and function and for tissue characterisation within the cardiovascular system. This review highlights the basic techniques and ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402081 Fri, 11 Nov 2011 05:00:00 +0100 5402081 http://www.medworm.com/index.php?rid=5402080&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1146%3Frss%3D1 A 14-year-old boy was under follow-up with the paediatric team for recurrent fainting episodes. These episodes had started when he was 8 years old and the most recent one had occurred while he was sitting on a chair. The patient's father, who had died in a road traffic accident while riding a motorbike, had experienced similar episodes as a child. Investigations including EEG and 12-lead ECG were normal apart from a marginally long QTc interval of 432 ms. An exercise ECG was arranged in view of this and the unusual history. The patient completed 13 min of a Bruce protocol exercise ECG. During the resting phase, he suddenly lost consciousness and collapsed. The ECG recording (figure 1) demonstrated a period of asystole lasting 24 s following which he ran into a junctional rhythm before retu... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402080 Fri, 11 Nov 2011 05:00:00 +0100 5402080 http://www.medworm.com/index.php?rid=5402079&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1140%3Frss%3D1 Conclusion Community-based surveillance for neonatal illness by CHWs using a simple 6-sign clinical algorithm is a promising strategy to effectively identify neonates at risk of mortality and needing referral to hospital. The YIS7 algorithm was also validated with high sensitivity and specificity at community level, and is recommended for routine household surveillance for newborn illness. ClinicalTrials.gov no. NCT00198627. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402079 Fri, 11 Nov 2011 05:00:00 +0100 5402079 http://www.medworm.com/index.php?rid=5402078&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1135%3Frss%3D1 Conclusions MA is seen as early as 2.8 years in children with sickle cell disease. Risk factors for MA include glomerular hyperfiltration, nutritional factors and vaso-occlusion but not haemolysis. Interventions addressing these factors may be useful. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402078 Fri, 11 Nov 2011 05:00:00 +0100 5402078 http://www.medworm.com/index.php?rid=5402077&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1129%3Frss%3D1 Reducing visual impairment and blindness in children in resource-poor countries is one of the key components of the major global prevention of blindness initiative, VISION 2020 the Right to Sight. Although visual impairment and blindness among children is much less common than among adults, the potential lifespan of a child means that the lifelong impact of such impairment is very large. Over 10 years ago, it was estimated that, globally, 1.4 million children were blind. Much has changed in the past 10–20 years and there is a need to reassess both the magnitude and causes of global childhood blindness and visual impairment. While the widespread implementation of vitamin A supplementation and measles immunisation programmes have led to a reduction in vitamin A deficiency-related blind... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402077 Fri, 11 Nov 2011 05:00:00 +0100 5402077 http://www.medworm.com/index.php?rid=5402076&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1124%3Frss%3D1 Conclusion There was a marked decline in disease incidence over the study period, particularly in more deprived areas. The magnitude of the association with deprivation, and the changing incidence, strongly suggest that environmental factor(s) are a major aetiological determinant in Perthes' disease. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402076 Fri, 11 Nov 2011 05:00:00 +0100 5402076 http://www.medworm.com/index.php?rid=5402075&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1118%3Frss%3D1 Conclusion NBS for CF leads to better lung function, nutritional status and improved survival in screened patients in early adulthood. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402075 Fri, 11 Nov 2011 05:00:00 +0100 5402075 http://www.medworm.com/index.php?rid=5402074&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1113%3Frss%3D1 Conclusion Capillary TSH screening in Down's syndrome is eminently feasible and should be performed annually from 1 year of age. Nearly all subjects with initial venous TSH ≥11.0 mU/l will require thyroxine treatment but most with TSH 6–10 mU/l only require surveillance initially. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402074 Fri, 11 Nov 2011 05:00:00 +0100 5402074 http://www.medworm.com/index.php?rid=5402073&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1112%3Frss%3D1 The parents of children with cerebral palsy are more likely to report stress than the parents of children without disability. Previous reports have indicated a twofold rise in the prevalence of stress and a four or fivefold increase in the prevalence of anxiety or depression among the parents of children with hemiplegia. A vicious circle may develop, with increased parental stress leading to reduced parenting performance, leading in turn to difficulties for the child that add to the parental stress. Most studies of parental stress and cerebral palsy have been small, with methodological inadequacies. Now a large study in eight European countries (England, Sweden, Northern Ireland, the Irish Republic, France (two regions), Denmark, Italy and Germany) has provided better data (Jackie Parkes a... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402073 Fri, 11 Nov 2011 05:00:00 +0100 5402073 http://www.medworm.com/index.php?rid=5402072&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1103%3Frss%3D1 Conclusion Multiple SDH over the convexity, interhemispheric haemorrhages, posterior fossa SDH, HII and cerebral oedema are significantly associated with AHT and should be considered together with clinical features when identifying the condition. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402072 Fri, 11 Nov 2011 05:00:00 +0100 5402072 http://www.medworm.com/index.php?rid=5402071&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1097%3Frss%3D1 Conclusions The thermostatic control with daily sterilisation was effective in capping hot water temperatures and therefore reduced scald risk. Although expected to save energy, fuel consumption was increased relative to the control group. Trial registration ClinicalTrials.gov ID: NCT00874692 (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402071 Fri, 11 Nov 2011 05:00:00 +0100 5402071 http://www.medworm.com/index.php?rid=5402070&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2F1093%3Frss%3D1 Introduction Quality improvement research strives to bridge the gap between ideal and actual care.1 Many paediatric diseases are rare, and thus there is insufficient evidence to define ‘ideal care’. Low prevalences and generally small patient numbers in centres in which children with rare diseases are treated create considerable barriers for clinical studies and for the development of evidence based guidelines. As a consequence, most existing guidelines are derived from studies in adults and lack any paediatric evidence.2 Here we focus on paediatric end-stage renal disease (ESRD) as an example of a clinical field in which these challenges are encountered. In contrast to the situation in adults, ESRD in children is a rare disorder: in the Western world, the annual incidence rate... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402070 Fri, 11 Nov 2011 05:00:00 +0100 5402070 http://www.medworm.com/index.php?rid=5402069&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F12%2Fi%3Frss%3D1 This study was clearly not designed to detect differences in either scald rates or Legionella infection. This paper neatly complements one we carried in March which demonstrated the effectiveness of thermostatic mixer valves in reducing water temperatures to a safe level.1... (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5402069 Fri, 11 Nov 2011 05:00:00 +0100 5402069 http://www.medworm.com/index.php?rid=5317391&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1092%3Frss%3D1 If Duchenne muscular dystrophy (DMD) could be turned into something more resembling the Becker type of muscular dystrophy, that would be a considerable advance. DNA technology may make it possible. These two types of muscular dystrophy each result from mutations in the dystrophin gene (DMD) but whereas in the Duchenne type the open reading frame is disrupted, in the Becker type it is preserved. Antisense oligonucleotides might at least partially correct the defect. PRO051 is an oligoribonucleotide that induces skipping of exon 51 of the DMD, affecting about 13% of patients with Duchenne dystrophy. In 2007, it was reported that injection of PRO051 induced dystrophin production in patients with Duchenne dystrophy producing a situation similar to that of Becker dystrophy. Now (New England Jou... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317391 Wed, 12 Oct 2011 04:00:00 +0100 5317391 http://www.medworm.com/index.php?rid=5317390&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1091%3Frss%3D1 Objective To study the aetiology and outcome of previously well children admitted to a paediatric intensive care unit (PICU) over a 5.5-year period (January 2004–June 2009) with coma (Glasgow Coma Score <12) unexplained by history and physical examination. Methods The study population included all children over the age of 1 month who were admitted to the intensive care during the study period. Data were collected by retrospective case note review. Patients with a history of trauma and in whom the aetiology was obvious on presentation (eg, meningococcal sepsis, diabetic ketoacidosis, primary hypoxic event) were excluded, as were those in whom seizures were the presenting symptom. Clinical course and final diagnosis were recorded and the neurological outcome was noted on discharge f... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317390 Wed, 12 Oct 2011 04:00:00 +0100 5317390 http://www.medworm.com/index.php?rid=5317389&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1088%3Frss%3D1 The authors compared pre-treatment and post-treatment characteristics of 206 prospectively enrolled patients with Kawasaki disease (KD) responsive to intravenous immunoglobulin (IVIG) with those of 23 (10% of total) IVIG non-responders. Demographic characteristics were similar in both groups. Compared to IVIG responders, non-responders had a longer total duration of fever and a higher incidence of coronary artery lesions. Prior to IVIG, non-responders had higher neutrophil differential and C-reactive protein, and lower cholesterol. 24 hours after the IVIG infusion, a total leucocyte count >13.1x109/l, neutrophil differential >51% and total protein <72 g/l showed reasonable sensitivity (91%, 91% and 64%, respectively) and specificity (89%, 76% and 78%, respectively) as independent ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317389 Wed, 12 Oct 2011 04:00:00 +0100 5317389 http://www.medworm.com/index.php?rid=5317388&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1087%3Frss%3D1 We present a case initially thought to be due to a prolactinoma. Case report An 11-month-old boy presented to our department with an 8-month history of progressive bilateral gynaecomastia and no other relevant history. The child was otherwise well and thriving. On examination, he had bilateral breasts Tanner stage 3, right>left. Both breasts felt cystic, with a pea-sized nodule palpable on the left (figure 1). A white fluid was expressed from the nipples. The rest of the examination was normal. Serum prolactin was initially raised (1151 mU/l) raising the suspicion of a prolactinoma; however, the MRI brain scan was normal and subsequent repeat prolactin was normal. Other investigations of the hypothalamic/pituitary/gonadal axis were normal. An ultrasound scan showed fluid filled cystic c... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317388 Wed, 12 Oct 2011 04:00:00 +0100 5317388 http://www.medworm.com/index.php?rid=5317387&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1085%3Frss%3D1 Conclusions In young infants, influenza A is a relatively mild disease compared to RSV and is primarily associated with upper respiratory tract manifestations. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317387 Wed, 12 Oct 2011 04:00:00 +0100 5317387 http://www.medworm.com/index.php?rid=5317386&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1082%3Frss%3D1 We present our experience in seven children with SCA over a 9-year period. Seven devices were placed for a total of 9754 PAC days during the study period. The median age at insertion was 6.3 years (range 3–15 years). The rate of PAC associated infection was 0.2 per 1000 PAC days. There were no episodes of thrombosis. The median length of time in situ during the study period was 3.7 years (range 1.3–7.5 years). Our experience highlights the safe and reliable use of PAC in children with SCA requiring regular blood transfusions when venous access has become a major problem. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317386 Wed, 12 Oct 2011 04:00:00 +0100 5317386 http://www.medworm.com/index.php?rid=5317385&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1077%3Frss%3D1 Conclusions Although there were deaths throughout the childhood and teenage years, the majority of children with bilateral CP are likely to survive to adulthood, especially if they do not have major functional impairment at 2 years. This confirms findings of other studies of children with CP. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317385 Wed, 12 Oct 2011 04:00:00 +0100 5317385 http://www.medworm.com/index.php?rid=5317384&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1072%3Frss%3D1 Persistent cloaco is the most severe type of anorectal malformation encountered in children. Patients with cloacal anomalies have a high incidence of associated anomalies most commonly: urinary tract and spinal. Persistent cloaca remains a difficult reconstructive challenge but it is now possible to anatomically correct the defect with surgery in the majority of patients. This review discusses embryology, prenatal diagnosis, neonatal physical and radiological findings. A summary of early management and investigation is provided and the commonest surgical reconstruction techniques are discussed. The main goals of surgical reconstruction are the achievement of bowel and bladder control for the child and normal sexual function in adult life. Although the majority of cloaca patients can achiev... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317384 Wed, 12 Oct 2011 04:00:00 +0100 5317384 http://www.medworm.com/index.php?rid=5317383&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1066%3Frss%3D1 Purpura fulminans (PF) is a haematological emergency in which there is skin necrosis and disseminated intravascular coagulation. This may progress rapidly to multi-organ failure caused by thrombotic occlusion of small and medium-sized blood vessels. PF may complicate severe sepsis or may occur as an autoimmune response to otherwise benign childhood infections. PF may also be the presenting symptom of severe heritable deficiency of the natural anticoagulants protein C or protein S. Early recognition and treatment of PF is essential to reduce mortality and to prevent major long-term health sequelae. However, management strategies require accurate identification of the underlying cause. This review focuses on the clinical features, differential diagnosis and laboratory features of the range o... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317383 Wed, 12 Oct 2011 04:00:00 +0100 5317383 http://www.medworm.com/index.php?rid=5317382&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1065%3Frss%3D1 A 29-month-old boy was referred to the general paediatrics clinic by his general practitioner with parental concerns regarding scars on his scalp. There were no other active concerns about his health. He achieved developmental milestones at the expected age. He had been admitted to another hospital at about 20 months of age with seizures, which resolved without recurrence and were attributed to hypoglycaemia of undefined aetiology. On examination, a round area of approximately 2 cm diameter with an irregular lumpy surface was visible in the central occipital area (figure 1). It was devoid of any hair and there were no signs of inflammation. A similar but smaller area approximately 1 cm in diameter was visible over the right side of the vertex. The rest of the general and systemic examinati... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317382 Wed, 12 Oct 2011 04:00:00 +0100 5317382 http://www.medworm.com/index.php?rid=5317381&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1060%3Frss%3D1 This article examines the concept, and limitations, of PR in relation to medical treatment decision-making. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317381 Wed, 12 Oct 2011 04:00:00 +0100 5317381 http://www.medworm.com/index.php?rid=5317380&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1052%3Frss%3D1 Despite recent overall improvement in the survival of under-five children worldwide, mortality among young infants remains high, and accounts for an increasing proportion of child deaths in resource-poor settings. In such settings, clinical decisions for appropriate management of severely ill infants have to be made on the basis of presenting clinical signs, and with limited or no laboratory facilities. This review summarises the evidence from observational studies of clinical signs of severe illnesses in young infants aged 0–59 days, with a particular focus on defining a minimum set of best predictors of the need for hospital-level care. Available moderate to high quality evidence suggests that, among sick infants aged 0–59 days brought to a health facility, the following clin... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317380 Wed, 12 Oct 2011 04:00:00 +0100 5317380 http://www.medworm.com/index.php?rid=5317379&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1048%3Frss%3D1 This article will outline the health problems inherent in an indigenous area of a developing country and will offer an alternative solution to reverse environmental risk factors associated with solid waste pollution and also actively improve child health. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317379 Wed, 12 Oct 2011 04:00:00 +0100 5317379 http://www.medworm.com/index.php?rid=5317378&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1047%3Frss%3D1 A previously fit and well 3-year-old girl presented with sudden onset of tetraparesis associated with urinary incontinence, following a brief episode of cervicalgia. Although she reported falling down a flight of stairs, this was not witnessed or heard by her mother. Clinical examination revealed generalised hypotonia, areflexia and tetraparesis. The child reported that sensation was intact, although the reliability of this was questioned based on the lack of objective response to cold spray. MRI showed a Chiari 1 malformation (figure 1) with increased T2-weighted signal change throughout an expanded cervical and upper thoracic cord (figure 2). Transverse myelitis can present in this manner and produce similar cord changes. However, the findings of a tight foramen magnum with associated sw... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317378 Wed, 12 Oct 2011 04:00:00 +0100 5317378 http://www.medworm.com/index.php?rid=5317377&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1042%3Frss%3D1 Discussion Children with IBD, particularly CD, have an elevated risk for immune-mediated conditions. This comorbidity adds to the burden of paediatric IBD, and suggests common aetiologic mechanisms. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317377 Wed, 12 Oct 2011 04:00:00 +0100 5317377 http://www.medworm.com/index.php?rid=5317376&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1038%3Frss%3D1 Conclusions TA seems no more common in paediatric and adolescent patients with CD on a GFD than in controls; its clinical evolution does not seem to impact on growth. Therefore, a long-term regular screening programme for thyroid disease may not be necessary for all patients with CD on a GFD, but only for those who are suspected of having thyroid diseases. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317376 Wed, 12 Oct 2011 04:00:00 +0100 5317376 http://www.medworm.com/index.php?rid=5317374&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1033%3Frss%3D1 Conclusions Paediatric antibiotic prescriptions dropped significantly following campaigns and the introduction of pneumococcal immunisation in France. Improvements are still needed regarding indications and choice of compounds. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317374 Wed, 12 Oct 2011 04:00:00 +0100 5317374 http://www.medworm.com/index.php?rid=5317373&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1032%3Frss%3D1 Duchenne muscular dystrophy (DMD) results when the open reading frame of the X linked dystrophin gene (DMD) is disrupted by deletions, duplications, point mutations or other rearrangements, inhibiting the production of dystrophin. In animal experiments, splice switching oligomers have been used to induce exon skipping and restoration of the open reading frame. Preliminary studies in boys with DMD have shown that 2' O-methyl-ribooligonucleoside-phosphorothioate and phosphorodiamidate morpholino oligomers can each be effective in restoring dystrophin production. Now, a trial in London and Newcastle (Sebahattin Cirak and colleagues. Lancet 2011;378:595–605; see also comment, ibid: 546–7) has confirmed that treatment with the phosphorodiamidate morpholino oligomer, AVI-4658, induce... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317373 Wed, 12 Oct 2011 04:00:00 +0100 5317373 http://www.medworm.com/index.php?rid=5317372&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1026%3Frss%3D1 Conclusions Intensive care improves the short and long term survival of children with leukaemia. 64% (95% CI 50% to 78%) of children with acute leukaemia who survived SAEV achieved long term survival. Prognosis mainly depends on age and leukaemia risk group. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317372 Wed, 12 Oct 2011 04:00:00 +0100 5317372 http://www.medworm.com/index.php?rid=5317371&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1025%3Frss%3D1 Idiopathic infantile hypercalcaemia reached epidemic proportions in the UK in the 1950s when recommended doses of vitamin D prophylaxis were much higher than the dose recommended now. Since most of the infants given the high dose remained unaffected, it was postulated that another factor, probably genetic, was at work but it was not known whether the problem was due to excessive activation or decreased inactivation of vitamin D. Now, researchers in Germany, Turkey and The Netherlands (Karl P Schlingmann and colleagues. New England Journal of Medicine 2011;365:410–21) have provided strong evidence that idiopathic infantile hypercalcaemia is caused by inactivation mutations in CYP24A1, the gene that encodes 25-hydroxyvitamin D 24-hydroxylase, the key enzyme of 1,25-dihydroxyvitamin D3 ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317371 Wed, 12 Oct 2011 04:00:00 +0100 5317371 http://www.medworm.com/index.php?rid=5317370&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1020%3Frss%3D1 Conclusions Genetic testing can be valuable in confirming the diagnosis. Increasing numbers of cases present prenatally or in early infancy, before onset of seizures, raising important questions about whether these children should have EEG monitoring and concerning the criteria for starting anticonvulsant therapy. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317370 Wed, 12 Oct 2011 04:00:00 +0100 5317370 http://www.medworm.com/index.php?rid=5317369&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1014%3Frss%3D1 Conclusions Overall, in infants who did and did not develop BPD, lung function improved throughout the neonatal period. Infants with more severe initial lung disease were more likely to develop moderate/severe BPD. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317369 Wed, 12 Oct 2011 04:00:00 +0100 5317369 http://www.medworm.com/index.php?rid=5317368&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1008%3Frss%3D1 Conclusions Whether defined by NCHS references or WHO standards, wasting among infants under 6 months is prevalent in many of the developing countries examined in this study. Use of WHO standards to define wasting results in a greater disease burden, particularly for severe wasting. Policy makers, programme managers and clinicians in child health and nutrition programmes should consider resource and risk/benefit implications of changing case definitions. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317368 Wed, 12 Oct 2011 04:00:00 +0100 5317368 http://www.medworm.com/index.php?rid=5317367&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F1003%3Frss%3D1 Conclusion Prevalence of transaminitis is significant in obese children and is associated with components of the metabolic syndrome. Lifestyle-based improvement in BMI SDS offers an effective tool for correcting transaminitis and should remain the central component of therapy. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317367 Wed, 12 Oct 2011 04:00:00 +0100 5317367 http://www.medworm.com/index.php?rid=5317366&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F998%3Frss%3D1 Conclusions The last 10 years has seen a very significant increase in the number of children requiring LTV in the UK with an increasing number cared for at home. This reflects both improving technology and increasing clinical expertise in paediatric non-invasive ventilatory support, and a continuing change in attitude towards long-term support, particularly in children with neuromuscular diseases. There are a substantial number of children who soon will require transition to adult services, yet few such services currently exist. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317366 Wed, 12 Oct 2011 04:00:00 +0100 5317366 http://www.medworm.com/index.php?rid=5317365&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F995%3Frss%3D1 One in 10 children starting school in the UK are already obese,1 yet a recent government poll indicated that parents worry more about their children being murdered than they do about their health.2 How do we begin to raise awareness about the considerable risks that accompany obesity? Not long ago I was approached by the Department of Health for my views on obesity prevention and the criteria health visiting services should be using to gauge unhealthy weight gain. At first thought it seemed logical to suggest a reversal of our criteria for weight faltering, namely to alert parents when their baby's weight crosses up two centiles or is above the 98th centile. However, a moment's reflection led me to consider that we might do better than this. Recent epidemiological studies have identified a... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317365 Wed, 12 Oct 2011 04:00:00 +0100 5317365 http://www.medworm.com/index.php?rid=5317364&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2F991%3Frss%3D1 Health professionals have a responsibility to safeguard children and adolescents up to the age of 18 years, that is, to recognise and respond to maltreatment.1 The terms ‘child abuse’ and ‘child maltreatment’ often evoke the image of an infant or young child. Yet up to a third of all children subject to a Child Protection Plan in the UK are adolescents.2 Twenty-seven per cent of serious case reviews conducted between 2009 and 2010 involved young people aged 11–17 years (figure 1).3 Many more vulnerable adolescents (eg, homeless youth or victims of gang violence) are not widely acknowledged by health and social care professionals or the media to be ‘abused’ or ‘maltreated’ in the conventional sense, limiting the application of usual safe... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317364 Wed, 12 Oct 2011 04:00:00 +0100 5317364 http://www.medworm.com/index.php?rid=5317363&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F11%2Fi%3Frss%3D1 Warning systems and ethics I can't remember an issue of Archives with greater breadth in every sense: geographical; biomedical and philosophical. Once assimilated, though, two distinct themes became clear; warning systems and ethics within child health which share similar uncertainties. Screening systems for adverse outcomes invariably entail difficult decisions; the trade off between over ‘identification’ of pathology, poorer specificity and greater economy with the risk of missing real cases, poorer sensitivity. Three papers demonstrate the tension in different ways. Three further papers, examine ethical equipoise from different angles: new techniques for previously incurable disease; the legal nuances of parental responsibility and the unique vulnerability of adolescents. Fi... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5317363 Wed, 12 Oct 2011 04:00:00 +0100 5317363 http://www.medworm.com/index.php?rid=5212571&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F990%3Frss%3D1 Urethral defects may result from trauma, infection, medical or surgical procedures, or congenital abnormalities. They may be difficult to repair, with varying results. Researchers in the USA and Mexico (Lancet 2011; 377:1175–82 see also Comment, ibid: 1130–1) have had complete success in reconstructing the urethras of five boys aged 10–16 years in Mexico City for defects due to urethral trauma. Muscle and epithelial cells were expanded from tissue biopsies from each patient and seeded onto a tubularised scaffold. Urethral reconstruction was performed using the tissue-engineered tubularised urethras. Follow- up ranged from 36 to 76 months and urethral biopsies were taken at 3, 12, and 36 months. The presence of epithelial and muscle lineages in the reconstructed urethra wa... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212571 Mon, 12 Sep 2011 04:00:00 +0100 5212571 http://www.medworm.com/index.php?rid=5212570&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F989%3Frss%3D1 More than a third of the children in the UK get head lice (pediculosis) in a year,1 and the prevalence of pediculosis increases in crowded conditions and with poorer hygiene.2 Increasing overcrowding of cities will result in an even greater prevalence. A primary school child needs about 1.5 mg of iron per day3 and iron loss is about 0.6 mg/day.3 A louse can cause blood loss of 1 mg/day, and this could therefore tip this balance in favour of iron deficiency anaemia, especially in a child who is already depleted in iron due to a poor diet. The effect of this infection has been poorly documented: most relevant articles are focused on the treatment and complications such as bacterial infection. Lice causing anaemia has been documented in cattle4 and, only recently, a case series in California ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212570 Mon, 12 Sep 2011 04:00:00 +0100 5212570 http://www.medworm.com/index.php?rid=5212569&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F988-b%3Frss%3D1 In their recent comprehensive and excellent review of paediatric encephalitis, Thompson and colleagues discuss non-infectious aetiologies, including some vasculitides—systemic lupus erythematosus, polyarteritis nodosa and antineutrophil cytoplasmic antibodies-associated vasculitis.1 In addition, Kawasaki disease should be considered as a possible cause of meningoencephalitis in children. The vasculitis of Kawasaki disease affects all medium size muscular arteries, including the cerebral vasculature.2 Cerebrospinal fluid pleocytosis and increased cytokine levels, similar to those reported in encephalitis, are also observed in Kawasaki disease and reflect intracranial inflammation that is possibly responsible for the characteristic irritability.2 3 Predominantly neurological presentati... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212569 Mon, 12 Sep 2011 04:00:00 +0100 5212569 http://www.medworm.com/index.php?rid=5212568&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F988-a%3Frss%3D1 High quality research benefits the health of infants, children and young people. Their well-being is the core business of paediatricians.1 Of course, the corollary is that paediatricians must be closely involved. Data gathered by the Science & Research Department of the Royal College of Paediatrics and Child Health (RCPCH) reveal trends that cannot be ignored. Our last census showed that less than 1 in 10 UK consultant paediatricians have identified time for research in their job plans (compared with 1 in 4 consultant physicians). A higher degree (MD or PhD) is held by 30% of consultant paediatricians aged 50 years and above, 25% aged 40–49 years, but only 12% of those aged 30–39 years. Less than 5% of the research spends of the major UK funders address child health issues.... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212568 Mon, 12 Sep 2011 04:00:00 +0100 5212568 http://www.medworm.com/index.php?rid=5212567&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F987-b%3Frss%3D1 Background Approximately 10% of children with epilepsy have absence epilepsy syndromes.1 The diagnosis is confirmed by recording events during a standard EEG recording synchronised with video.2 However, non-epileptic absence-like behaviour is common in children, and although there may be clinical pointers to non-epileptic behaviours, an EEG is often requested.3 Objective To describe the EEG (synchronised with video) results in children referred with suspected absence seizures. Methods We reviewed 3021 EEG reports from 1 January 2007 to 31 December 2009 carried out in the regional paediatric EEG department of the John Radcliffe Hospital, Oxford, and selected all referrals for possible epileptic absences. Children who had complete records in their first EEG prior to the commencement of antie... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212567 Mon, 12 Sep 2011 04:00:00 +0100 5212567 http://www.medworm.com/index.php?rid=5212566&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F987-a%3Frss%3D1 The weight Z-score is a useful concept when studying the nutrition and growth of individuals. The weight Z-score is the number of standard deviations by which a weight differs from the mean at a specific age. A Z-score of –1 is a weight on the –1 SD line (16th centile). A Z-score indicates the change in the Z-score over a time interval. A negative Z-score accompanies an individual who is ‘falling off their centiles’ even if gaining weight slowly. The Z-score can be estimated from a centile chart, calculated from the mean and SD or looked up in a table. If the population data are skewed, then complex modelling can been applied, as seen in the WHO charts, but the arguments outlined here still stand. Observant researchers will have noticed this asymmetry in that the +1... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212566 Mon, 12 Sep 2011 04:00:00 +0100 5212566 http://www.medworm.com/index.php?rid=5212565&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F983%3Frss%3D1 Revalidation has begun with relicensing in 2009. All paediatricians will have to demonstrate that they meet generic standards in the General Medical Council's (GMC) Good Medical Practice for continued relicensing. Paediatricians on the specialist register will have to demonstrate that they meet the specialist standards set by the College and approved by the GMC in order to recertify. Five satisfactory, signed-off annual appraisals with personal development plans, with 5 years of continuing professional development records (including evidence of learning such as reflective notes), one–two iterations of multisource feedback by colleagues, one–two iterations of multisource feedback by patients, evidence of involvement in audit (and research, publications), outcome data, complaints... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212565 Mon, 12 Sep 2011 04:00:00 +0100 5212565 http://www.medworm.com/index.php?rid=5212564&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F977%3Frss%3D1 Clinical confidence and coordinated multidisciplinary care can influence the course of anorexia nervosa in children and adolescents. Sicker and younger patients with anorexia nervosa often present first to a paediatrician, requiring early recognition and appropriate management. Paediatric knowledge and skills are also needed to manage the impact of eating disorders on growth and development. This review provides practical guidance on the management of anorexia nervosa for paediatricians, in the areas of assessment, acute management and re-feeding, and long-term monitoring. In the absence of a strong evidence base for some of these recommendations, local protocols based on best practice guidelines can reduce anxiety, increase cooperation and reduce risk. (Source: Archives of Disease in Chil... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212564 Mon, 12 Sep 2011 04:00:00 +0100 5212564 http://www.medworm.com/index.php?rid=5212563&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F969%3Frss%3D1 Inadequately remedied abuse and neglect has costly implications for children's physical and emotional health, behaviour, growth and development. It is relevant to major physical and psychological causes of adult morbidity and mortality, involvement in crime as victim and perpetrator and parenting difficulties, but not inevitably so. Resilience varies, and its promotion is a professional priority. Achieving recovery is a complex therapeutic task, often extending over years, not simply a matter of providing new parents. Neurobiology increasingly explains why this is so. Effective safeguarding means keeping long-term responsibilities in mind throughout. Balancing risks and benefits of intervention requires consideration of the implications of the quality of relationships which neglect and abu... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212563 Mon, 12 Sep 2011 04:00:00 +0100 5212563 http://www.medworm.com/index.php?rid=5212562&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F963%3Frss%3D1 Conclusions The overall prevalence of DR among children with T1D was 11.8% (35/297) showing no decrease over the past 17 years; in girls, DR was diagnosed more often in the present than in the former study, but there was no change in the prevalence among the boys. Glycaemic control had remained unchanged. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212562 Mon, 12 Sep 2011 04:00:00 +0100 5212562 http://www.medworm.com/index.php?rid=5212561&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F960%3Frss%3D1 When children are considered for participation in research, British and international guidelines suggest that they should provide assent in addition to their parents' consent. However, examination of these guidelines shows there is confusion regarding the concept of assent. Furthermore, the need for assent may cause problems. The guidelines should be revised: the parents of incompetent children should consent for them and competent children should consent on their own behalf. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212561 Mon, 12 Sep 2011 04:00:00 +0100 5212561 http://www.medworm.com/index.php?rid=5212560&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F959%3Frss%3D1 A 2-year-old boy was referred to our department for gradual onset of breathlessness over 2 months. Physical examination revealed tachypnoea and bilaterally reduced breath sounds. Chest x-ray showed opacification of both lung fields (figure 1), and chest CT scan revealed a huge mediastinal mass originating from the thymus (15.2 x 11.2 x 8.8 cm) filling the whole thoracic cavity (figure 2). An uneventful percutaneous biopsy excluded lymphoma; the mass was subsequently resected and found to be a type B1 thymoma. The child has been followed up without recurrence for 3 months. Thymoma is exceedingly uncommon in children and young adults.1 Type A has neoplastic epithelial cells with oval/spindle-shaped nuclei and in type B the cells have a predominantly round/polygonal appearance. Type B thymoma... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212560 Mon, 12 Sep 2011 04:00:00 +0100 5212560 http://www.medworm.com/index.php?rid=5212559&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F954%3Frss%3D1 Conclusions Autistic features have not previously been remarked upon in studies of non-referred samples with SCTs, yet the rate is substantially above population levels in this sample, even when attention is restricted to early-identified cases. The authors hypothesise that X-linked and Y-linked neuroligins may play a significant role in the aetiology of communication impairments and ASD. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212559 Mon, 12 Sep 2011 04:00:00 +0100 5212559 http://www.medworm.com/index.php?rid=5212558&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F948%3Frss%3D1 Conclusion A majority of surveyed Flemish physicians appear to accept physician-assisted dying in children under certain circumstances and favour an amendment to the euthanasia law to include minors. The approach favoured is one of assessing decision-making capacity rather than setting arbitrary age limits. These stances, and their connection with actual end-of-life practices, may encourage policy-makers to develop guidelines for medical end-of-life practices in minors that address specific challenges arising in this patient group. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212558 Mon, 12 Sep 2011 04:00:00 +0100 5212558 http://www.medworm.com/index.php?rid=5212557&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F947%3Frss%3D1 Although commonly found in adults with the nephrotic syndrome, membranous nephropathy is a rare cause of childhood nephrotic syndrome. The underlying pathogenesis involves the formation of subepithelial deposits of immune complexes in the glomeruli. Exogenous antigens may be involved in cases secondary to hepatitis B or C, congenital syphilis, systemic lupus erythematosus and some cancers. Two endogenous antigens have been described: neutral endopeptidase (in neonatal membranous nephropathy affecting the infant of a neutral endopeptidase deficient mother who developed antibodies to fetal neutral endopeptidase that then crossed the placenta and reacted with the infant's glomerular neutral endopeptidase) and the M-type phospholipase A2 receptor (PLA2R). The latter is found in podocytes and a... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212557 Mon, 12 Sep 2011 04:00:00 +0100 5212557 http://www.medworm.com/index.php?rid=5212556&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F942%3Frss%3D1 Conclusions Physical inactivity appears to be the result of fatness rather than its cause. This reverse causality may explain why attempts to tackle childhood obesity by promoting PA have been largely unsuccessful. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212556 Mon, 12 Sep 2011 04:00:00 +0100 5212556 http://www.medworm.com/index.php?rid=5212555&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F936%3Frss%3D1 Conclusion Without therapeutic hypothermia, the outcome of children was determined by variables suggestive of the severity of encephalopathy/encephalitis at admission. Hypothermia may have pivotal impacts on the outcome of children according to the timing of cooling initiation following acute encephalopathy/encephalitis. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212555 Mon, 12 Sep 2011 04:00:00 +0100 5212555 http://www.medworm.com/index.php?rid=5212554&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F932%3Frss%3D1 Conclusion If this situation were replicated in the PICUs throughout the UK, it would represent a significant increase in the number of organs available for transplantation. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212554 Mon, 12 Sep 2011 04:00:00 +0100 5212554 http://www.medworm.com/index.php?rid=5212553&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F931%3Frss%3D1 In the treatment of asthma, the control of airway eosinophilic inflammation has been considered to be of prime importance in recent decades. Airway remodelling (goblet cell hyperplasia, subepithelial collagen deposition and smooth muscle hypertrophy on bronchial biopsy) is considered to be the basis of long-term deterioration of lung function in patients with asthma and has been attributed mainly to eosinophilic airway inflammation. Recently, however, in vitro studies have suggested that repeated bronchoconstriction may be equally important in the genesis of airway remodelling. Now, a study of adults with mild asthma by researchers in Southampton (Grainge CL, and colleagues. New Engl J Med 2011;364:2006–15; see also editorial, ibid: 2058–9) has shown that airway remodelling occ... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212553 Mon, 12 Sep 2011 04:00:00 +0100 5212553 http://www.medworm.com/index.php?rid=5212552&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F927%3Frss%3D1 Conclusion Child Death Overview Panels now have the responsibility to review child deaths using similar methods but relying upon data forms rather than the case record. Analysis of contributory factors on a national scale has the potential to improve understanding of why children die and indicate strategies to reduce child mortality. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212552 Mon, 12 Sep 2011 04:00:00 +0100 5212552 http://www.medworm.com/index.php?rid=5212551&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F926%3Frss%3D1 We present a case of pneumatosis intestinalis tracking to the scrotum demonstrated on the CT scan. A teenager presented with diffuse abdominal pain, bloody diarrhoea and a day later he developed bilateral painless scrotal swelling. The swelling was brilliantly transilluminated, but not fluctuant. Additionally, there was crepitus around the sacrum, extending to the buttock but there was no sign of peritonism or abdominal distension. The patient had undergone bone marrow transplant previously and currently he was immunosuppressed to manage severe graft versus host disease. An ultrasound of the scrotum confirmed a gaseous swelling and a high resolution CT scan revealed signs of extensive gas forming infection in the pelvis, probably originating from the colon and extending to the perineum and... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212551 Mon, 12 Sep 2011 04:00:00 +0100 5212551 http://www.medworm.com/index.php?rid=5212550&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F922%3Frss%3D1 Conclusion Agreement within diagnostic categories might be improved by greater training of assessors in the use of the technique. This level of performance compares well with that of other coding systems upon their target groups. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212550 Mon, 12 Sep 2011 04:00:00 +0100 5212550 http://www.medworm.com/index.php?rid=5212549&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F916%3Frss%3D1 Conclusions There are significant deviations in the proportion of children outside normal limits (±2 SD) of the WHO standards. This was true for all children, including those who were exclusively breastfed. Hence, adoption of the WHO growth charts could have consequences for clinical decision-making. These findings advocate the use of national references in Belgium and Norway, also for breastfed children. (Source: Archives of Disease in Childhood) Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212549 Mon, 12 Sep 2011 04:00:00 +0100 5212549 http://www.medworm.com/index.php?rid=5212548&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F911%3Frss%3D1 Introduction Over the past three decades HIV has caused significant morbidity and mortality among children, with sub-Saharan Africa bearing the brunt of the epidemic.1 Of the estimated 33 million people living with HIV, 2.5 million are children under the age of 15 years, of whom 2.3 million live in sub-Saharan Africa.2 Substantial progress has been made over the past decade in reducing the number of children infected with HIV as well as paediatric HIV-related deaths. Increasing availability of effective drug regimens to reduce mother-to-child transmission of HIV (the main route of HIV infection in children) has led to a global decline in new paediatric infections from 500 000 in 2001 to an estimated 370 000 in 2009.1 Fewer infected children and increased access to HIV treatment for those w... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212548 Mon, 12 Sep 2011 04:00:00 +0100 5212548 http://www.medworm.com/index.php?rid=5212547&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F909%3Frss%3D1 The optimal duration of exclusive breast feeding is a subject of continuing debate. Most recently Fewtrell and colleagues1 have challenged the evidence underpinning the 2002 World Health Assembly endorsement of the recommendation that in both developing and developed countries exclusive breast feeding should be for a minimum of 6 months.2 They questioned whether there was sufficient evidence to support the change from 4 to 6 months in developed countries and they also suggested that the 6-month policy could be disadvantageous to some infants. Questioning the validity of any aspect of breast feeding policy generates widespread media, professional and public interest and with the possibility of misinterpretation there is a potential risk that the key health message of breast milk being the n... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212547 Mon, 12 Sep 2011 04:00:00 +0100 5212547 http://www.medworm.com/index.php?rid=5212546&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F907%3Frss%3D1 Although no politician will commit career suicide by admitting it, rationing of healthcare is inevitable, whatever the healthcare system, recession or no recession. Medicines, particularly biologicals, modern surgery and intensive care are pushing back the boundaries of what can be done to salvage seemingly hopeless situations, to give but three examples. The UK will never be able to pay for all possible medical care for all our citizens, irrespective of cost and benefit. Thus, if medical rationing is inevitable then it should be as fair and transparent as possible, and conducted by experts not politicians. The National Institute for Health and Clinical Excellence (NICE) has the unenviable task of determining who can be prescribed expensive medications or treatments used in large numbers w... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212546 Mon, 12 Sep 2011 04:00:00 +0100 5212546 http://www.medworm.com/index.php?rid=5212545&cid=s_32752_33_f&fid=32752&url=http%3A%2F%2Fadc.bmj.com%2Fcgi%2Fcontent%2Fshort%2F96%2F10%2F905%3Frss%3D1 Professor Maitland and colleagues recently published the results of a large international study to examine the role of fluid boluses in the management of seriously ill febrile children in Africa.1 While the study was extremely well conducted, we are seriously concerned about the conclusions and implications of the paper, which states:The results of this study challenge the importance of bolus resuscitation as a life-saving intervention in resource-limited settings for children with shock who do not have hypotension and raise questions regarding fluid-resuscitation guidelines in other settings as well. Already in the UK, the media has responded with alarming headlines, such as ‘a trial in Africa has raised major questions about the safety of the routine treatment given to children suf... Archives of Disease in Childhood journals http://www.medworm.com/rss/comments.php?id=5212545 Mon, 12 Sep 2011 04:00:00 +0100 5212545