Diagnosis and management of children with adrenal insufficiency
Adrenal insufficiency (AI) is a rare diagnosis. Symptoms may be vague, easily overlooked or attributed to more common childhood diagnoses. Early diagnosis and treatment is essential as untreated AI may present as adrenal crisis, a potentially fatal condition. Adrenal insufficiency may result from lesions at all levels of the hypothalamic pituitary adrenal axis. Accurate diagnosis is essential as the treatment and prognosis of AI differs according to the site and nature of the lesion. Cortisol is secreted in a circadian manner. (Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - June 14, 2023 Category: Pediatrics Authors: Joanne Blair Tags: Symposium: endocrinology Source Type: research
Self-assessment
(Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - June 14, 2023 Category: Pediatrics Authors: Givani Amarakoon, Sahana Rao Tags: Self-assessment Source Type: research
Primary ciliary dyskinesia: what the general paediatrician needs to know
Primary ciliary dyskinesia is a multisystem disease with a range of phenotypes. Lung involvement is common, as abnormalities of cilial function lead to reduced airway clearance of mucus. Identifying children early is crucial in avoiding progression to bronchiectasis, and to allow timely support of growth and development. Key clinical features include a daily wet cough, neonatal chest symptoms, situs abnormalities, perennial rhinitis and chronic ear or hearing symptoms. These patients should be referred for specialist respiratory review and investigation. (Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - June 13, 2023 Category: Pediatrics Authors: Julie Riechmann, Elizabeth Clare Gregson, Robert William Morton Tags: Occasional Review Source Type: research
Parent-led ward rounds on a neonatal unit: how and why?
You're about to start reviewing a baby ready to present on the consultant ward round. (Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - June 12, 2023 Category: Pediatrics Authors: Oliver Rackham Tags: Personal practice Source Type: research
Editorial Board
(Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - May 27, 2023 Category: Pediatrics Source Type: research
Understanding and interpreting thyroid function tests
Thyroid function tests are commonly requested on children and young people in primary and secondary care settings. These tests include markers of thyroid function including thyroid stimulating hormone (TSH) and free thyroxine (FT4) concentrations. This short article aims to equip the reader to interpret them correctly. Not all biochemical parameters outside the reference range will require therapeutic intervention and there are a number of potential associated pitfalls. For example, a set of thyroid function test results may not be a cause for concern in one setting but require immediate action in another clinical context....
Source: Paediatrics and Child Health - May 22, 2023 Category: Pediatrics Authors: Veena Sharma, Timothy Cheetham, Claire Wood Tags: Symposium: endocrinology Source Type: research
Management of excessive weight gain in childhood
Obesity can be termed a chronic disease defined by excessive adiposity presenting a risk to health, with wide-ranging complications and reduced life expectancy. The rising prevalence of obesity in childhood poses a significant public health challenge, in the UK and globally. Obesity is a complex disease with sequelae in every system in the body. These include type 2 diabetes, hypertension, obstructive sleep apnoea, dyslipidaemia, non-alcoholic fatty liver disease, increased risk of malignancy, orthopaedic conditions, and mental health problems. (Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - May 20, 2023 Category: Pediatrics Authors: Katherine Hawton, Shelley Easter, Claire Semple, Jennifer Cox, Amy Fitzgerald, Rhian Augustus, Dinesh Giri, Julian Hamilton-Shield Tags: Symposium: Endocrinology Source Type: research
A practical approach to growth hormone deficiency
Short stature is one of the most frequent reasons for referral to the paediatric endocrinologist. Familial short stature is the commonest cause; however, a child who is unexpectedly small for their family requires careful evaluation. Short stature in itself is not a disease, but growth failure can be a sensitive sign of underlying health issues in children and adolescents. Differentiating short stature due to a non-endocrine cause from an endocrine cause is critical. Of the endocrine causes, growth hormone deficiency (GHD) is rare with a prevalence of approximately 1:4,000 to 1:10,000 but is an important condition warranti...
Source: Paediatrics and Child Health - May 20, 2023 Category: Pediatrics Authors: Mehul Dattani, Neha Malhotra Tags: Symposium: Endocrinology Source Type: research
Current understanding and management of paediatric diabetic ketoacidosis
Diabetic Ketoacidosis (DKA) is a serious complication of insulin deficiency. It is typically seen in children and young people with Type 1 Diabetes Mellitus, either at first presentation, or in established disease, for instance due to poor compliance, equipment failure, or concurrent illness. Insulin deficiency leads to hyperglycaemia causing osmotic fluid loss, dehydration and electrolyte derangement. Osmotic symptoms of polyuria and polydipsia due to hyperglycaemia may give way to oliguria or anuria as circulatory insufficiency develops. (Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - May 14, 2023 Category: Pediatrics Authors: Daniel Leach, Sumana Chatterjee, Proteek Sen, Diksha Shirodkar, Dinesh Giri Tags: Occasional review Source Type: research
NeoTips: getting started with common neonatal procedures
Neonatal procedures can be challenging and difficult for many neonatal practitioners, clinical/trust fellows and doctors in training to undertake. In this guide, we detail the steps and tips that can be used as a guide by practitioners for the following procedures: IV cannulation, longline (PICC) insertion, umbilical arterial catheterisation and umbilical venous catheterisation, needle thoracocentesis, chest drain insertion, intubation and lumbar puncture. The guide features pictures of equipment required with a further ‘tips’ section detailing anecdotal advice on how best to aim for success in these procedures. (Sourc...
Source: Paediatrics and Child Health - May 4, 2023 Category: Pediatrics Authors: Qasim Malik, Puneet Nath, Asad Abbas Tags: Occasional review Source Type: research
Editorial Board
(Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - April 28, 2023 Category: Pediatrics Source Type: research
Twins: a neonatal perspective
Multiple gestational pregnancies have become more common with the development of assisted reproductive technologies and increasing maternal age. It is important to be aware of the factors that need to be considered when expecting their impending arrival to the neonatal unit. Their antenatal course has unique considerations and monochorionicity can complicate their antenatal and postnatal course so closer monitoring is required. Perinatal interventions for optimal outcomes are undertaken according to local policies, NICE and RCOG recommendations. (Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - April 26, 2023 Category: Pediatrics Authors: Tanoj Gopalan Kollamparambil, Neha Sharma Tags: Symposium: Neonatology Source Type: research
Social determinants of health and the neonate in the neonatal intensive care
It is increasingly recognised that social determinants of health such as socioeconomic inequalities, parental education level, addiction behaviors, mental health difficulties and breast-feeding rates all influence immediate and long-term outcomes in neonatal intensive care unit (NICU) graduates. Awareness, recognition and appropriate management of these risks may help alleviate some of these effects. This review looks at various social determinants and their effects on patients and families in the NICU. (Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - April 17, 2023 Category: Pediatrics Authors: Roshan Adappa, Sybil Barr Tags: Symposium: Neonatology Source Type: research
Intravenous bronchodilator choices in acute severe and life-threatening asthma
When inhaled therapy fails to reverse bronchospasm during a severe asthma attack, intramuscular epinephrine and intravenous (IV) magnesium sulphate (MgSO4), salbutamol, and aminophylline reach bronchial smooth muscle cells by the vascular route. There is no consensus on how long to wait before abandoning inhaled therapy, little agreement on which IV drug to use first, in what order, what dose to use, and IV delivery speed. IV therapy can begin with MgSO4 40 mg–75 mg−1 as a bolus rather than over 20 minutes, followed by salbutamol 15 mg.kg−1 over 10 minutes. (Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - April 12, 2023 Category: Pediatrics Authors: William FS. Sellers, Mike FM. James Tags: Symposium: Intensive care Source Type: research
Thyroid disorders in neonates: A practical approach to congenital hypothyroidism and thyrotoxicosis
Congenital hypothyroidism is one of the most common causes of preventable intellectual disability in the UK and worldwide. Early diagnosis is critical to allow for early intervention. At present, 1 in 2000 to 1 in 3000 babies born in the UK have congenital hypothyroidism. Of these, most will not display any clinical manifestations or symptoms in the first few weeks of life. In short, babies will develop intellectual disability if they go undiagnosed. It is therefore no surprise that the day 5 blood spot is essential for good outcomes and harm reduction. (Source: Paediatrics and Child Health)
Source: Paediatrics and Child Health - April 12, 2023 Category: Pediatrics Authors: Srinivas Nallagonda, Amile Inusa, Rohit Gupta, Madhavi Nallagonda Tags: Symposium: Neonatology Source Type: research
