Highlights from the literature
Fruit juice – good for you? Child or adult, drinking fruit juice must be a great way of contributing to your five-a-day of fruits and vegetables. There is a lot of free sugar in 100% fruit juice and no fibre. Do these high sugar drinks contribute to obesity? Nguyen M et al (JAMA Pediatr 2024;178:237–246) have completed a systematic review focussing on the evidence that fruit juice has an impact on weight gain and BMI by examining MEDLINE, Embase, and Cochrane databases searching up to 18 May 2023. They looked for prospective cohort studies of at least 6 months and randomised clinical trials (RCTs) of at least 2...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Tags: Miscellanea Source Type: research
Accuracy of point-of-care testing for the diagnosis of respiratory pathogens in a paediatric intensive care setting
Respiratory tract infections contribute significantly to paediatric intensive care unit (PICU) admissions. Early diagnosis supports treatment, cohorting and antimicrobial stewardship. Rapid point-of-care (POC) multiplex PCR techniques show promise in improving antimicrobial and investigation stewardship across healthcare settings.1 However, debate exists regarding their role and accuracy.2 3 We sought to evaluate the feasibility and accuracy of respiratory pathogen POC testing in our PICU. All patients admitted to the regional Northern Ireland PICU undergo nasal/nasopharyngeal swab respiratory pathogen POC testing. The Bio...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Norman - Bruce, H., Wilson, K., Waheed, S., Richardson, J., Groves, H. Tags: PostScript Source Type: research
Early detection of gastrointestinal polyps and neoplasia following radiation for childhood-onset cancer
A massive and rapidly increasing burden of care exists for all physicians caring for the 80–90% of childhood cancer survivors. All paediatricians and general practitioners (GPs) seeing these adolescents must attain a sound knowledge of the risks, current and future, faced by these young people. Provision of improved care and appropriate surveillance during adolescence, with information for adult services at time of transition, will also empower patients and their families to advocate for and act upon the essential requirements for long-term surveillance. Not all these risks are yet commonly recognised. Exposure to ab...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Atlas, G., Zacharin, M. R. Tags: PostScript Source Type: research
Amiodarone in a rush: caution on speed of delivery and new guidance
A boy aged 11 months presented to his local hospital with a short history of being febrile with vomiting. He was found to be shocked with a pulsed broad complex tachycardia of around 240 and increased work of breathing. He was managed as per the APLS (Advanced Paediatric Life Support) protocol and had short-lived terminations after his first two shocks. He was loaded with amiodarone over 5 min prior to his third shock, but promptly arrested with loss of electrical activity requiring 20 min cardiopulmonary resuscitation. This transitioned to a return of broad complex tachycardia with output and a further 20 min of shocks an...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Banerji, O., Schadenberg, A. Tags: PostScript Source Type: research
Identifying empty salbutamol inhalers by weighing the canister
Metered dose inhalers (MDIs), due to their reliability and ease of delivery of medications, have been commonly used in the treatment of asthma. The National Institute for Health and Care Excellence quality standards (2018) recommend assessment of adherence, medication review and inhaler technique at every asthma review. The MDIs contain a propellant along with an active drug to expel the labelled number of actuations. This design feature makes it difficult for patients to identify when their inhaler is empty. Studies have shown that up to 86 actuations can be done just with the inhaler propellant after all the medication h...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Nagakumar, P., Evans, T., Frost, S. Tags: PostScript Source Type: research
Skeletal surveys in intubated patients: does UK clinical practice match national guidelines?
Introduction The investigation of suspected paediatric non-accidental injury in children under 2 years of age includes a skeletal survey, which is also indicated in older children on a case-by-case basis. In 2018, the UK national standards for the ‘radiological investigation of suspected physical abuse in children’ were updated by relevant radiology and radiography bodies and endorsed by the Royal College of Paediatrics and Child Health.1 The standards now mandate a skeletal survey within 72 hours of presentation, ideally within 24 hours. Initial and targeted follow-up images facilitate the crucial timing of an...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Manning, G. L. P., Sharpe, E., Calder, A., Brierley, J. Tags: PostScript Source Type: research
Quality improvement project assessing the feasibility of using canister weight to estimate remaining doses in a salbutamol pressurised metered-dose inhaler
Pressurised metered-dose inhalers (pMDIs) containing salbutamol are an essential medicine for children with acute asthma. Salamol chlorofluorocarbon-free inhaler (‘Salamol’; IVAX Pharmaceuticals, Waterford, Ireland) is the most widely prescribed salbutamol pMDI in England (figure 1), costing the National Health Service £7.2 million in the 2022–23 financial year.1 In common with the other salbutamol pMDIs it lacks an integrated dose counter (IDC). Without an IDC, most children and families cannot accurately identify when a pMDI is empty.2 Thus, families may continue to use a pMDI that contains no act...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Beckett, R. S., Jagadish, A., Carroll, W., Gilchrist, F. J. Tags: PostScript Source Type: research
Towards evidence-based medicine for paediatricians
What could it be? It is often the case we would like to know what the chances of different types of diagnosis are, or the chance of a scan finding something or some things with a presentation. These types of questions can be answered in an ‘evidence-based’ way, but they rarely are even thought about let alone addressed. Their appraisal should follow the same model as others; does the paper produce valid findings? Are they meaningful and important? How far is the paper from the population or patient I am thinking of—too far to be helpful? Validity is best gained from an appropriate population, evaluated wi...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Phillips, B. Tags: ADC Archimedes Source Type: research
Supporting parents of children born with differences in sex development
Scenario A baby born via an uneventful delivery in the birth centre was unwell after delivery. They were found to have electrolyte abnormalities on blood tests and ambiguous genitalia. They were admitted to the neonatal unit and a postnatal diagnosis of congenital adrenal hyperplasia (CAH) was made after investigations. Structured clinical question How can healthcare professionals deliver a diagnosis of differences in sex development (DSD) to parents of affected children (population), and support parents’ psychological needs around diagnosis (intervention), in a way that promotes positive parental mental health (outc...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Baig, A. Tags: ADC Archimedes Source Type: research
'No One Is Talking About This - rare diseases in childhood
Patricia Lockwood’s 2021 novel, No One Is Talking About This, demonstrates the challenge of rare diseases in childhood through its account of a family whose baby is diagnosed with Proteus syndrome.1 Set in the USA, the book is divided into two distinct halves. The first concentrates on the social media obsession of the unnamed protagonist (the child’s aunt); in the second, the narrative focuses on the baby’s diagnosis. No One Is Talking About This is autofictional—Lockwood dedicates the book to her niece, who lived for 6 months with Proteus syndrome. Fiction can help illustrate the experiences of pa...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Fisayo, T. Tags: Voices from literature Source Type: research
Point break: atraumatic first rib fracture in a surfer
A 16-year-old boy presented to the emergency department with a 2-week history of atraumatic left-sided chest pain. This was following a surfing holiday involving 3–4 hours of sessions daily. His pain started after extending his arm while surfing. Initial investigations including ECG and bloods were unremarkable except for mildly raised alkaline phosphatase. Chest X-ray (figure 1) revealed possible first rib fracture. CT of the chest (figure 2) confirmed the diagnosis and showed callus formation. First rib fractures are often the result of major trauma and are associated with injury to the great vessels or spine.1 How...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Bradford, J., Raval, K., Jacoby, J., Andrews, E. Tags: Miscellanea Source Type: research
Lost in research: children, healthcare and epistemic injustice
The National Institute for Health and Care Excellence (NICE) published guidance on Babies, Children and Young People’s Experiences of Healthcare in 2021.1 Seventeen systematic reviews provided evidence for recommendations, covering topics ranging from communication preferences to involving children and young people (CYP) in designing healthcare provisions. The United Nations Declaration on the Rights of the Child2 sets out a right for children to be consulted on matters that affect them, supporting a societal trend towards including children in governance.3 The NICE guideline committee therefore included young people...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: McTaggart, J., Beeden, E., Farooq, A. Tags: Viewpoint Source Type: research
Hyperpigmentation at diabetes technology sites may be indicative of evolving Addisons disease
A 12-year-old boy with type 1 diabetes mellitus and coeliac disease reported 2–3 months of skin darkening at his insulin pump cannula and continuous glucose monitor sites (figure 1). For the preceding 9 months, he had localised itching and redness, which had been managed as allergic contact dermatitis by a dermatologist. He continued to use the dressings and these symptoms had improved. Hyperpigmentation was noted over his knuckles and periorally. He had no symptoms of adrenal insufficiency and was gaining weight (98th centile) and height (50th centile). A synacthen test had a suboptimal peak cortisol (370 nmol/L (&g...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Moon, R. J., Rowland, A. C., Davies, J. H. Tags: Miscellanea Source Type: research
Stepwise genetic approach for the diagnosis of primary ciliary dyskinesia in highly consanguineous populations
Conclusions
In highly consanguineous regions, a stepwise genetic testing approach is recommended. This approach may be particularly useful in areas where the ability to obtain confirmatory diagnostic tests through other modalities is less accessible. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Authors: Gatt, D., Golan Tripto, I., Levanon, E., Arwas, N., Hazan, G., Alkrinawi, S., Goldbart, A. D., Aviram, M. Tags: Original research Source Type: research
The OUtMATCH study: treating multiple allergies
It is recognised that of those children who do have allergies (about 8% of the population), 30–80% have responses to multiple foods. A double blind, placebo-controlled, randomised clinical trial, the Omalizumab as Monotherapy and as Adjunct Therapy to Multi-Allergen Oral Immunotherapy in Food Allergic Participants (OUtMATCH) study is a three phase study comparing omalizumab to placebo in children with multiple food allergies and is in its first phase. The study then goes on to phase two, a longer-term (52 weeks) treatment with omalizumab with oral immunotherapy and then the third stage will assess the introduction of...
Source: Archives of Disease in Childhood - April 18, 2024 Category: Pediatrics Tags: Miscellanea Source Type: research
