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Postexposure prophylaxis for varicella/shingles: a review of the UKHSA guidelines
Background Varicella zoster virus (VZV) is a human herpes virus that causes chickenpox (or varicella) and shingles. Chickenpox, which occurs with primary VZV infection, is highly contagious and is typically a mild illness in childhood. Shingles, which occurs with reactivation of latent VZV, is less common in childhood than adulthood but can still affect both immunocompromised and immunocompetent children following previous chickenpox infection or varicella vaccination. Information about the current guideline The UK Health Security Agency (UKHSA) ‘guidelines on postexposure prophylaxis (PEP) for varicella/shingles&rsq...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Jeyaraj, R., Alexander, E., Cutino-Moguel, T., Li, S., Kainth, R. Tags: Guideline review Source Type: research

Guideline review: Sudden and unexpected postnatal collapse - BAPM framework
Background Sudden unexpected postnatal collapse (SUPC) is a rare but devastating occurrence in seemingly well babies after birth. The exact incidence and indeed definition (Box 1) of SUPC varies widely, but is estimated to occur in 2.6–19 per 100 000 live births in the UK. Approximately one-third to one half of babies will die following SUPC. Post-asphyxial encephalopathy may occur in up to three quarters of those babies who do not have an underlying cause identified despite extensive investigation. Box 1Definition of SUPC as defined in the BAPM Framework1 Baby born at ≥35/40 gestation. Well at birth with a 5 min ...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Cotton, H., Osmond, E. Tags: Guideline review Source Type: research

Gene therapy for spinal muscular atrophy
GlossaryVg/kg = vector genomes/kilogram SMA = Spinal Muscular Atrophy AAV9 = Adeno-associated virus serotype 9 CHOP-INTEND: Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders, a motor assessment tool devised for infants with SMA. This has 16 items graded on a scale of 0 to 4, with 0 being no response and 4 being complete response. Introduction Spinal muscular atrophy (SMA) is a severe neurodegenerative condition resulting from recessive mutations in the SMN1 gene and insufficient survival motor neuron (SMN) protein production.1 Lack of SMN protein causes irreversible degeneration of lower mot...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Gowda, V. L., Jungbluth, H., Wraige, E. Tags: Medicines update Source Type: research

How to use lumbar puncture manometry in children
Measurement of cerebrospinal fluid pressure through lumbar puncture (LP) manometry is an essential practical skill all paediatricians should possess competency in. The ability to perform manometry is crucial in the diagnosis of idiopathic intracranial hypertension and can provide critical information on raised (or lowered) intracranial pressure in other clinical scenarios. Practitioners should be familiar with the procedure and in particular with equipment available to them locally. In this article, we will describe an approach to LP manometry. The online supplemental material includes an instructional video as well as sup...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Holland, J. A., Funnell, J. P., Mittal, R., Krishnakumar, D. Tags: Open access, Interpretations Source Type: research

How to use the Bristol Stool Chart in childhood constipation
Constipation in children is common and is a frequent cause for healthcare attendances in both primary and secondary care. The Bristol Stool Chart has become ubiquitous as an aid in the diagnosis and treatment of constipation, but many clinicians may not be aware of its origins or strengths and weaknesses. In this article, we outline the history and rationale behind the development of the Bristol Stool Chart and how it should be used in childhood constipation. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Harvey, S., Matthai, S., King, D. A. Tags: Editor's choice, Interpretations Source Type: research

Fifteen-minute consultation: Recognition and management of eating disorders presenting to the emergency department
Eating disorder presentations in children and young people during the COVID-19 pandemic have increased, and this has become a common presentation to paediatric emergency departments (EDs). We cover a structured approach on identifying and managing these presentations within the ED including history taking, what to look for on examination, what investigations are needed and how to decide who requires admission to hospital. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Rothwell, L., Vivek, K., Nicholls, D., Maconochie, I., Dyer, E. M. Tags: Best practice and Fifteen Minute Consultations, COVID-19 Source Type: research

Fifteen-minute consultation: A structured approach to the child with palpable cervical lymph nodes
This article presents an evidenced-based approach to evaluating these patients. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Ruffle, A., Beattie, G., Prasai, A., Jeanes, A., Paddock, M. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Fifteen-minute consultation: Rectal bleeding in children
Bleeding per rectum in children is an infrequent presentation associated with a wide range of differential diagnoses, from benign to life-threatening. Irrespective of the underlying aetiology, it is typically a worrisome symptom for caregivers. Published data are limited, particularly for the UK population, from which to provide clear evidence-based guidance for assessment and management of infants, children and young people presenting with bleeding per rectum. In this Fifteen-Minute Consultation, we therefore explore the common aetiologies and combine opinions from acute paediatrics, paediatric gastroenterology and paedia...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Metezai, H., Wahid, A., Jones, C., Evans, J. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Fifteen-minute consultation: Management of constipation in childhood
Constipation is common in childhood. It is a frequent presentation to primary care and common reason for referral to secondary and tertiary care. In the majority of cases, childhood constipation is idiopathic, with no significant underlying cause, but still presents a significant issue to patients, families and healthcare providers. We consider a case of idiopathic constipation, review the current evidence base for investigations and treatment and suggest practical management strategies. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Copley, S., Lawson, M., King, D. A. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Epistle
As I began to write this Epistle, I heard the exciting news of India making history with the first successful landing of the Chandrayaan-3 spacecraft near the south pole of the moon. The scientific and technological advancement which made this feat possible are to be shared, to allow other countries to follow suit. At E&P, we also aim to share the knowledge and skills to improve clinical practices across different continents. This month’s journal brings a series of such articles. In the Medicines update section, an important article by Vasantha Gowda and colleagues outlines the innovative gene therapy (onasemnoge...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Gupta, N. Tags: Highlights from this issue Source Type: research

How to design and deliver a successful paediatric placement for medical students
This article provides a template for a paediatric placement appealing to current medical students and future generations constructed on the strong foundations of evidence-based practices in medical education. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Vallabhaneni, P., Thankachan, D. Tags: Learning and teaching Source Type: research

Fifteen-minute consultation: What do paediatricians need to know about child refugee and migrant health needs?
Increasing numbers of refugees have entered Europe over recent years, reflective of international crises caused by conflict in Afghanistan, Syria and the Horn of Africa. Approximately one-third are children and young people aged under 18 years, many unaccompanied. These individuals often arrive at their most vulnerable following hazardous journeys with complex healthcare needs.1 2 In 2019, more than two-thirds of the global refugee population originated from just five countries: Syria, Venezuela, Afghanistan, South Sudan and Myanmar. In the same year, only 0.5% of the world’s refugees had successfully resettled elsew...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Ryan, A., Kelly, A. Tags: Public health Source Type: research

Review of the 2021 Resuscitation Council United Kingdom guideline for the emergency treatment of anaphylaxis
Background It is estimated that 1 in 300 people will experience anaphylaxis at some point1 with approximately 20–30 deaths per year in the UK from anaphylaxis.2 The treatment, investigation and follow-up of patients with anaphylaxis are frequently suboptimal, with approximately 50% of anaphylaxis episodes not treated appropriately with intramuscular epinephrine (adrenaline),3 despite previous guidance recommending epinephrine as first-line treatment. This is often due to a failure to recognise anaphylaxis which can be difficult due to the variety of signs and symptoms that may occur, none of which are specific to ana...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Ball, E., Purchase, T., Morgan, J. Tags: Guideline review Source Type: research

Diagnosis, management and prevention of button battery ingestion in childhood: a European Society for Paediatric Gastroenterology Hepatology and Nutrition position paper
Background Button battery (BB) ingestions are a serious risk in the paediatric population, the complications of which involve gastrointestinal (GI), respiratory and vascular structures, and include perforation, stenosis, inflammation and fistulation.1 While information on UK incidence is presently unknown, child death due to BB ingestion has been the focus of a recent Healthcare Safety Investigations Branch (HSIB) inquiry2 and an NHS National Patient Safety Alert,3 both highlighting the significant risk this poses to children worldwide. In 2019, the US National Poison Centre reported 3467 cases of BB ingestion (10.47 per m...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Machta, J., Hyer, W. Tags: Guideline review Source Type: research

Early switch of intravenous to oral antibiotic therapy in clinically well neonates with a probable bacterial infection is as effective as a full course of intravenous antibiotics therapy
Study design Design: Randomised open-label, non-inferiority trial. Study question Setting: Multicentre including 17 teaching hospitals in the Netherlands between February 2018 and May 2021. Patients: 510 infants were included in the study. Inclusion criteria were greater than 35 weeks’ gestation at birth, with weight of at least 2 kg, who were intended to receive a 7-day course of antibiotics for probable bacterial infection. Infants were recruited at postnatal age between 0 day and 28 days. Probable bacterial infection was defined as the presence of maternal risk factors or clinical symptoms and elevated inflammator...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Abdalhady, M., Harrison, C. M. Tags: Picket Key publications in paediatrics: Picket Source Type: research