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Immediate kangaroo care significantly reduces mortality at 28 days for low-birthweight infants
Conclusions: Low-birthweight infants receiving immediate KMC following delivery have a significantly lower mortality rate... (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Farquharson, S. Tags: Picket Key publications in paediatrics: Picket Source Type: research

Acute kidney injury during diabetic ketoacidosis increased the risk of microalbuminuria in children with type 1 diabetes mellitus
Study design: Twin-centre retrospective analysis. Setting: Two urban academic children’s hospitals in the USA. Patients: 2345 children diagnosed with type 1 diabetes mellitus (T1DM) <18 years old and at least 1-year duration of diabetes between 2006 and 2019. Outcomes: The primary outcomes were incidence of acute kidney injury (AKI) and presence of microalbuminuria. AKI diagnosis was based on Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Microalbuminuria was defined as urine albumin to creatinine ratio of ≥30 mg/g or excretion of ≥30 mg of albumin in 24 hours. Follow-up: The me...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Hayes, A. L., McAllister, J. Tags: Picket Key publications in paediatrics: Picket Source Type: research

Enhancing parental experience and improving communication through parental participation on PICU ward rounds
The problem The adequacy of communication in staff–parent relationships plays a key role in parental experience of intensive care units. Parents’ experiences in intensive care settings are recognised as playing an integral part in defining the quality of care for their child.1 Prior to this initiative, our paediatric intensive care unit (PICU) requested parents to leave during morning ward rounds. This was in keeping with 3 out of the 12 large PICU training centres in the UK. Consultant and senior nursing staff members updated parents following completion of ward rounds; however, timing was variable and depende...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Ross, P., Willis, S., Corrigan, J., Keenan, H., Tough, H., Terris, M., Mallett, P., Richardson, J. Tags: Quality improvement Source Type: research

Improving the environmental sustainability of paediatric care
Accelerated global warming is directly related to greenhouse gas (GHG) emissions. In order to achieve international and national set targets on reducing GHG emissions, paediatricians should aim to decrease GHG emissions associated with paediatric care, when this is not in conflict with patient outcomes. In this article, we review literature on practical ways to encourage environmentally sustainable paediatric care and identify areas where more evidence is required. Finally, we introduce readers to the principles of sustainable healthcare which may be used to help guide further efforts to reduce the environmental impact of ...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Spooner, R., Glover Williams, A., Roome, C. Tags: Quality improvement Source Type: research

Digital health education: the need for a digitally ready workforce
This article explains the importance of digital health education, lists accessible resources and provides examples of health apps that can be recommended. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Holland Brown, T. M., Bewick, M. Tags: Open access, Editor's choice, Learning and teaching Source Type: research

Experience-based learning: an alternative approach to teaching medical students on paediatric placements
This article introduces experience-based learning (ExBL), an evidence-based framework to guide clinicians involved in teaching medical students. It describes how the framework was developed and outlines its central principles – promoting students’ participation in patient care and supporting them to reflect on their experiences. It then offers practical guidance on how clinicians can use ExBL to reformulate and refresh paediatric placements within the constraints facing clinical education and practice. The issue You regularly teach medical students on paediatric clinical placements in your hospital. Sometimes y...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Conn, R. L., Speyer, F., Davison, G. L., Dornan, T. Tags: Learning and teaching Source Type: research

Patient and public involvement in paediatric medical education
This article aims to identify how organisations can facilitate the involvement of paediatric patients and their parents/carers. While involving children in research can present challenges, we describe examples where organisations have successfully involved young people in clinical research and selection of research topics. Involving paediatric patients and their parents/carers in medical education helps develop a patient centred approach to practice for medical students. Participation of paediatric patients in objective structured clinical examination (OSCE) examinations is employed by many medical schools, however allowin...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Donnelly, S., Ferris, K., Kennedy, N., Bourke, T., O'Donoghue, D. Tags: Learning and teaching Source Type: research

Paracetamol overdose in children: management following an initial N-acetylcysteine regimen
Key points Blood tests that guide management of paracetamol overdose (POD) include alanine aminotransferase, aspartate aminotransferase, bilirubin, urea, creatinine, electrolytes, clotting profile, blood gas, glucose, lactate and paracetamol concentration. Coagulopathy (international normalised ratio >2, Prothrombin time> 20 s) in children with POD indicates acute liver failure (ALF) and is managed with continuation of N-acetylcysteine, instituting ALF protocol (https://bspghan.org.uk/hepatology-guidelines) and contacting the tertiary liver unit. In cases of intentional POD, mental health and safeguarding assessments...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Rajaraman, N., Gray, L., Anderson, M., Kelgeri, C. Tags: Medicines update Source Type: research

Misplaced gastric tube: a case of oesophageal perforation in a preterm neonate
A 25-week infant, born in a level one unit, was intubated, ventilated and transferred to the tertiary neonatal centre without incident. He had acute respiratory collapse on day 2 with a right-sided tension pneumothorax (figure 1A), which was drained. He remained stable until day 7 when he deteriorated, with increased oxygen requirement and poor feed tolerance (figure 1B). On review, there were gastric tube aspirates over the preceding days with high pH (>6–8), consisting mainly of large volumes of undigested milk. Questions What do these radiographs show? What is your differential diagnosis? What would your concer...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Granger, C. L., Ashton, C., Tinnion, R. Tags: Epilogue Source Type: research

Incidental splenomegaly in a teenager
A healthy male teenager presented to his primary care paediatrician for a routine check-up including receipt of vaccines. On clinical examination, isolated splenomegaly was noted, a few days later confirmed by MRI (figure 1). Extensive investigations excluded an underlying oncological, infectious or metabolic disease. Due to bicytopenia (haemoglobin 69 g/L, white blood count 1.52x109/L, platelet count 151x109/L) with suspected autoimmune pathogenesis, extended immunological diagnostics were performed. This revealed an increased serum IgG concentration (19.3 g/L (5.9–12.5)) and an increase in double-negative T cells (...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Baghin, V., Prader, S., Sirin, S., Pachlopnik Schmid, J., Trück, J. Tags: Epilogue Source Type: research

Look up! An unexpected cause of abdominal pain in an infant
A previously well 9-month-old girl attended the emergency department following episodes of profound pallor, inconsolable crying and drawing her legs up. She had no vomiting, change in stooling or fever. She was born at term with no neonatal complications. On examination, her vital signs were stable, and her abdomen was soft. Blood tests including inflammatory markers were unremarkable. Test your knowledge Which diagnosis is most likely? Appendicitis Intussusception Mesenteric adenitis Strangulated inguinal hernia Viral gastroenteritis Which investigation would you like to perform? Abdominal X-ray Abdominal ultrasound CT of...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Kendall, I., McKenna, M., Conn, R. L., Dick, A. C. Tags: Epilogue Source Type: research

Not so fun at the funfair...
A 1-year-old girl presented with a 3-day history of non-bilious vomiting, reduced intake and lethargy. Her last bowel movement was 4 days prior. She was previously well with no ill contacts or foreign travel. On examination, she was tachycardic with a prolonged capillary refill time. Her abdomen was soft, not distended with no palpable masses. Blood tests including full blood count, renal and C reactive protein (CRP) were normal. She initially received supportive treatment with intravenous fluids and analgesia. On day 4 of admission, an abdominal X-ray (AXR) was performed due to persistent vomiting (figure 1). Test your kn...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: McLaughlin, D., Hanna, M., Eastwood, P., Mallett, P., Thompson, A. Tags: Epilogue Source Type: research

Unusual case of respiratory distress in a newborn
A male infant was born by elective caesarean section at term to consanguineous parents. He required inflation breaths at birth and had signs of respiratory distress for which he was admitted to the neonatal unit. Physical examination revealed tachypnoea with moderate subcostal recession and an intermittent cough. Air entry was equal, but crepitations were heard throughout the chest. His heart sounds were normal and were best heard on the right side. He was commenced on oxygen via a headbox at 3 hours of age, treated for suspected early-onset infection, and a chest X-ray (CXR) was performed (figure 1). Following the X-ray, ...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Kershaw, M., Lok, A., Robson, E. Tags: Epilogue Source Type: research

PREDICT-Australian and New Zealand guideline for mild to moderate head injuries in children
Introduction Approximately 1.4 million people a year attend emergency departments (EDs) in England and Wales with a recent head injury. Between one-third and a half of these are children aged under 15 years.1 A large majority of these present with a normal or minimally impaired conscious level; in Australia and New Zealand, 98.3% of children presenting to EDs with a head injury have a Glasgow Coma Scale (GCS) score of 14 or 15 on initial assessment.2 Many of these children can be safely discharged, but a small minority may have intracranial injury, skull fracture or other significant injuries. Twenty of every 1000 children...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Anthony, L., James, D. Tags: Guideline review Source Type: research

Fifteen-minute update: International normalised ratio as the treatment end point in children with acute paracetamol poisoning
Paracetamol is one of the most frequent reasons for poisonings across the UK with an estimated 90,000 patients and 150 deaths annually. International normalised ratio (INR) may be elevated due to hepatocellular damage and is frequently used to monitor progress on N-acetyl cysteine. N-acetyl cysteine is associated with reduced activity of vitamin K dependent clotting factors leading to a benign elevation of INR. In asymptomatic children with normal aspartate transaminase/alanine transaminase, isolated borderline elevation of INR following paracetamol overdose should be reviewed for possible N-acetyl cysteine induced elevati...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Dayasiri, K., Rao, S. Tags: Problem solving in clinical practice Source Type: research