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Fifteen-minute guide: Vitamin K administration in neonates: the challenges clinicians face
Scenario A mother of a baby boy born at 36 weeks’ gestation is declining vitamin K administration. The baby is well and has no family history. The mother says that there is not enough evidence to prove that vitamin K works and is worried about the risk of cancer. The clinician’s job is to present and weigh up the current evidence on neonatal administration of vitamin K. Introduction Vitamin K deficiency bleeding (VKDB) is a rare but potentially fatal haemostatic disorder. It manifests as bleeding at multiple sites in otherwise healthy infants.1 It occurs in the first 6 months of life and is almost entirely prev...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Haddick, A., Berry, S., Sweet, D. G. Tags: Medicines update Source Type: research

How to use the fractional exhaled nitric oxide test
Measurement of fractional exhaled nitric oxide (FeNO) has become a mainstream, NICE-recommended, objective test of asthma severity. We explore the uses and practical issues with the FeNO test using clinically relevant questions for general paediatricians. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Hoggins, R., Velpula, M., Woodward, S., Tighe, M. P. Tags: Open access, Interpretations Source Type: research

Guideline review NICE Clinical Knowledge Summary: balanitis in children
Introduction Balanitis is an inflammatory condition typically affecting the glans penis but is commonly associated with inflammation of the foreskin and is consequentially known as ‘balanoposthitis’. It is an illustrative term of which there are numerous causes and risk factors. Among young men, up to 6% are shown to suffer from balanitis.1 Prevalence is higher in uncircumcised men2 due to the accumulation of microorganisms, secretions and epithelial debris between the penis and foreskin.3 In October 2018, the National Institute for Health and Care Excellence (NICE) produced a Clinical Knowledge Summary (CKS) o...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Javaid, A. A., Powell, K., Awad, K. Tags: Guideline review Source Type: research

Managing febrile neutropenia in the UK in 2020
Background Neutropenic sepsis is a life-threatening medical emergency in paediatric haematology and oncology patients. It is a complication of myelosuppressive therapy used to treat children with cancer. Improvement in supportive care in oncology has seen the mortality from febrile neutropenia (FN) fall from 40% to 1%–3% in the last 50 years,1 with the risk of FN in children being reported as low as 0.4%–1%.2 However, many children will still undergo frequent and long inpatient admissions to the hospital, due to fever and neutropenia, while remaining clinically well with no identifiable source of infection. Thi...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Guram, S., Vedi, A. Tags: Guideline review Source Type: research

Twin girls with hypophosphataemic rickets and papilloedema
A 7 year-old twin girl with hypophosphataemic rickets was evaluated for a recent onset of mild strabismus. She was a homozygous twin sister with hypophosphataemic rickets diagnosed at the age of 2 years, with a mutation in intron 21 of the PHEX gene, which was also present in her sister. The girls’ clinical histories were remarkable for an important lower limb varus that progressively improved after starting phosphate supplementation with a galenical solution (Joulies solution 1 mmol phosphate/ml) and vitamin D 1,25 OH. During the examinations, both girls were in good general condition. Physical examinations were unr...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Migliarino, V., Magnolato, A., Barbi, E. Tags: Epilogue Source Type: research

Painless expanding facial swelling
Case history A previously healthy 11-year-old girl sustained a mosquito bite on her right cheek while on holiday in rural Bangladesh. A painless lump developed at the site, and over the ensuing 2 months gradually expanded. She was otherwise completely asymptomatic; there was no family history of note. On examination, there was obvious swelling affecting the right cheek and visible abnormality of the upper gum with displacement of the right upper central incisor (figure 1). Figure 1Swelling of gum and displacement of tooth. The facial swelling measured 4x5 cm, was firm to touch, non-fluctuant, painless and non-tender; n...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Heaton, P. A., Zaborowski, K. P., Holwill, S. D., Merrick, G. D., Paul, S. P. Tags: Epilogue Source Type: research

Young boy with a long history of splenomegaly and cytopenia
A 15-year-old boy was admitted with a history of cytopenia (white blood cell count 3.170/μm, platelets 90.000/μm) associated with splenomegaly, found during investigations for recurrent mild jaundice due to Gilbert’s syndrome. He was in good general health, without systemic symptoms; therefore, the leading causes of asymptomatic splenomegaly were excluded. Coagulation, liver tests and abdomen ultrasound (US) were normal, showing a hepatopetal portal flow to the colour-Doppler. There was no sign of haemolysis on haematology investigations. The C reactive protein, immune globulins levels and erythrocyte sedimenta...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: De Nardi, L., Zanchi, C., Basso, L., Sanabor, D., Di Leo, G., Barbi, E. Tags: Epilogue Source Type: research

A well-appearing infant with a sudden anisocoria
Case presentation A 10-month-old boy was admitted to the emergency department due to a sudden onset of left unilateral mydriasis (figure 1). His medical history was unremarkable. A minor head trauma 2 days before was reported, without alarming signs or symptoms. His mother was putting him to sleep, after coming back from work, when she noticed a different pupil size and promptly went to the ED with her husband. The parents denied any use of medications, including nebulised therapy or direct contact with plants. The child was well appearing and his vital signs were within the standard age limits. His extraocular motility wa...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Servidio, A. G., Peri, F., Tenore, A., Cesca, L., Diplotti, L., Dall'Amico, R., Barbi, E. Tags: Epilogue Source Type: research

Sinister sinusitis
Two previously well Caucasian teenage girls with no significant travel or family history were admitted with sinusitis refractory to treatment with antibiotics. Both had progressive symptoms despite broad-spectrum antibiotics and developed involvement of other systems, ultimately requiring admission to the paediatric intensive care unit (PICU). They were subsequently diagnosed with the same condition and made an excellent recovery. The first girl, 14 years old, originally presented to her general practitioner with a sore throat, nasal congestion, and fever. Despite multiple courses of antibiotics over the following month sh...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Brighouse, J. R., Shepherd, K., Santos, R., Shivamurthy, V. Tags: Epilogue Source Type: research

How to interpret spinal imaging in paediatric trauma
Spinal injuries in children are fortunately rare; however, it is important that they are assessed and managed in a timely manner. A systematic approach to traumatic spinal injuries should be used, by following recent evidence and national protocols, in order to avoid misinterpretation and potentially, inappropriate discharge. The aim of this article is to highlight the concepts of spinal imaging in paediatric trauma with regards to indications, interpretation and limitations. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Richards, A., Dadnam, C., Murch, H. K. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Fifteen-minute consultation: Guide to paediatric voice disorders
Paediatric voice disorders in the normal paediatric population ranges from 6% to 20%. We outline the important features in the initial evaluation of a persistent altered cry or voice in children and highlight the subsequent management currently used by ear, nose and throat (ENT) surgeons and speech and language therapists (SLTs). It is important to appreciate that there are stark differences between a child and adult larynx due to anatomical and physiological changes during development. The voice history elicited from both child and parent includes birth and developmental history, hearing, early feeding and respiratory fun...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Watson, N. A., Orton, K. A., Hall, A. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Fifteen-minute consultation: How to spot serious heart disease in the newborn
Congenital heart disease (CHD) is common and important as it remains a leading cause of neonatal morbidity and appreciable mortality. Prenatal diagnosis, the presence of a murmur, cyanosis, tachypnoea and/or poor or differential peripheral pulses raise the suspicion of CHD aided by differential pre/postductal saturations. Yet even serious CHD may not be considered when such clues are absent. Nevertheless, there are clinical cues which may alert the clinician to the possibility of a significant CHD which may lead to an early and accurate diagnosis and appropriate intervention to achieve best results. This paper addresses th...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Menahem, S., Sehgal, A. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Flexibility
can mean many things. An unusual yoga pose or the ability to take the afternoon off for your child’s nativity play. In medicine, the concept implies adaptation depending on need and situation. Most paediatricians know what is expected of them, but when asked to be flexible, their expectations may be challenged. Those with firm boundaries may resist being flexible, colleagues perceiving them as being ‘difficult’ or resistant to change. In fact, their response may protect them from feeling overwhelmed and enable them to keep working in the long term. Others enjoy variety and unexpected challenges, the unpr...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Furnell, C., Finlay, F. Tags: Wellbeing at work Source Type: research

Fifteen-minute consultation: The review of a child with trisomy 21 (Downs syndrome)
This article aims to cover the important aspects to cover when seeing children with DS for their routine follow-up in the neurodevelopmental or general paediatric clinic. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Dalrymple, R. A., Somerville, L. H., Hamza, S., Matta, N. Tags: Editor's choice, Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Fifteen-minute consultation: The efficient investigation of infantile and childhood epileptic encephalopathies in the era of modern genomics
The investigation of children presenting with infantile and childhood epileptic encephalopathies (ICEE) is challenging due to diverse aetiologies, overlapping phenotypes and the relatively low diagnostic yield of MRI, electroencephalography (EEG) and biochemical investigations. Careful history and thorough examination remain essential as these may identify an acquired cause or indicate more targeted investigation for a genetic disorder. Whole exome sequencing (WES) with analysis of a panel of candidate epilepsy genes has increased the diagnostic yield. Whole genome sequencing (WGS), particularly as a trio with both parents...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Perry, L. D., Hogg, S. L., Bowdin, S., Ambegaonkar, G., Parker, A. P. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research