Explore the vast range of titles available.

There is limited data on the cardiovascular effects of norepinephrine (NE) in neonates. Our objective was to describe the clinical responses in neonates treated with NE infusion. This retrospective cohort study included neonates with evidence of shock and those who received NE infusion. Primary outcome: changes in mean blood pressure (MBP) at 6, 12, and 24 h post-initiation of NE. Secondary outcomes: Changes in (i) diastolic BP, systolic BP, and vasoactive inotrope score (VIS) at 6, 12, and 24 h, (ii) urine output after initiation of NE ii) pH, lactate, fraction of inspired oxygen (FiO2) after initiation of NE, and (iv) adverse outcomes. Fifty infants received NE with mean (SD) gestational age of 34.3 (4.3) weeks and a mean birth weight of 2215 (911) g. Treatment began at a median age of 36 (IQR: 15.2, 67.2) hours of life and lasted 30.5 (IQR: 12.7, 58) hours. MBP improved from 34.4 mm Hg (SD: 6.6) at baseline to 39.4 mm Hg (SD: 10.5, p < 0.001) at 6 h, to 39.6 mm Hg (SD: 12.1, p = 0.002) at 12 h and to 40.4 mm Hg (SD: 15.5, p = 0.004) at 24 h after NE initiation. Vasoactive inotrope score declined from 30 (20, 32) to 10 (4, 30; p < 0.001) at 24 h. Urine output improved within 24 h [1.5 ml/kg/h (0.5, 2.3) at baseline to 3 (1.9, 4.3) at 24 h; p = 0.04]. Oxygen requirement decreased after NE initiation.Conclusion: The use of NE appears to be effective and safe for treating systemic hypotension in neonates. Trial registration: Being a retrospective study, trial registration was not considered.What is known:• Dopamine has traditionally been used as the initial agent for treatment of neonatal hypotension.• Norepinephrine has recently been recommended as the first-choice vasopressor agent to correct hypotension in adults and pediatric patients, with insufficient data on the cardiovascular effects of NE in neonatesWhat is new:• Mean blood pressure improved significantly at 6, 12, and 24 h with reduction in vasoactive infusion score at 12 and 24 h after norepinephrine infusion.• No significant change in heart rate or abnormal abdominal adverse effects noted in this study.

BackgroundNeonates admitted in the neonatal intensive care unit are vulnerable to acute kidney injury leading to worse outcomes. It is important to identify “at-risk” neonates for early preventive measures.MethodsThe study was a multicenter, national, prospective cohort study done in 11 centers in India. A multivariable logistic regression technique with step-wise backward elimination method was used, and a “Risk Prediction Scoring” was devised [the STARZ score].ResultsThe neonates with admission in the NICU within <25.5 h of birth, requirement of positive pressure ventilation in the delivery room, <28 weeks gestational age, sepsis, significant cardiac disease, urine output <1.32 ml/kg/h or serum creatinine ≥0.98 mg/dl during the first 12 h post admission, use of nephrotoxic drugs, use of furosemide, or use of inotrope had a significantly higher risk of AKI at 7 days post admission in the multivariate logistic regression model. This scoring model had a sensitivity of 92.8%, specificity of 87.4% positive predictive value of 80.5%, negative predictive value of 95.6%, and accuracy of 89.4%.ConclusionsThe STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit.ImpactThe STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit.These neonates with a higher risk stratification score need intense monitoring and daily kidney function assessment.With this intensification of research in the field of AKI risk stratification prediction, there is hope that we will be able to decrease morbidity and mortality associated with AKI in this population.

BackgroundThe morbidity and mortality from the novel coronavirus 19 are less pronounced in children compared with adults. It’s impact on the health care services can however indirectly impact the health care delivery to children including accessibility.ObjectivesThe objective of this survey therefore was to obtain feedback from parents about how they accessed health care for their unwell children during the peak of the COVID 19 pandemic and challenges faced in the process.MethodsAll parents attending the paediatric wards and assessment units of a district hospital in England with their children were prospectively interviewed over a 2-month period using a self-administered questionnaire. Information obtained included health care service accessed during the national lock-down if needed, time to obtain care, mode of consultation, satisfaction with treatment and any deterrents to seeking health care in the hospital. Data was analysed using Microsoft excel and presented using descriptive statistics.ResultsWe surveyed 103 parents of whom 49(47.6%) sought healthcare for their children from 1st April to 30th June 2020. There were 31 males and 18 females (M: F, 1: 0.58 ). Number of children seeking health care monthly were 12(24.55%), 22(44.9%) and 15(30.6%) in April, May and June respectively. Source of health care was as follows: General Practitioners 25(51%); National Health Service 111 helpline 15(30.6%); Hospital paediatric services 8(16.3%). One parent was unable to access vaccination services. Time to obtain help was <1hr in 20, 1–2 hours in 11 and >2hrs in 16 with the greatest delays from GP and 111 services. There was delayed diagnosis of a ruptured appendix in 1 patient which was however successfully treated. The predominant form of consultation was via telephone (83%) while video and in person consultations constituted 13% and 4% respectively. Thirty-two (64%) parents expressed satisfaction with treatment received, 8(16%) were neither satisfied nor dissatisfied while 9 (18.4%) expressed dissatisfaction. Twelve (24.5%) parents who would ordinarily have sought hospital care did not for the following reasons: fear of the virus (6), stay at home orders (2), uncertainty about hospital services (1), reluctance to burden the hospital services (1), no reason given (2). However of parents who did not seek hospital care, 83.3% were satisfied with the treatment received.ConclusionsPaediatric health care remained accessible by most parents during the National lockdown with some expected delays. There is no evidence that any critically ill children were missed although impact on child safeguarding issues could not be looked into. Majority of consultations were virtual and we conclude that strengthening of newly introduced virtual consultations may reduce burden on hospital services during such lock-downs. The public need to be made aware about continuity of hospital services and accessing these for any acutely unwell child needing urgent attention. A larger study over a period of time may be needed to look into the impact of virtual consultation on possible missed or delayed diagnosis.

Gastric acid-reducing medications (ARMs) such as proton pump inhibitors (PPIs) and histamine type 2 receptor blockers (H2 blockers) are crucial in pediatric care for treating various gastrointestinal conditions. These medications are frequently used to treat erosive esophagitis, peptic ulcer disease, and gastroesophageal reflux disease (GERD). ARMs are essential to the administration of eosinophilic esophagitis and infection. Additionally, literature also supports its use in alleviating drug-induced dyspepsia, preventing stress-related mucosal damage, and lowering the risk of acid aspiration syndrome during anesthesia in critical care settings. Despite the widespread indications of ARMs, PPIs, the most potent acid suppressants, present concerns regarding safety and their inappropriate use in pediatrics. This paper aims to address these gaps by providing comprehensive, practical recommendations for ARM use in pediatric settings. The methodology involved a structured literature review and opinions from 24 pediatric specialists across India, including neonatologists, general pediatricians, pediatric gastroenterologists, a pediatric hepatologist, pediatric nephrologists, a pediatric pulmonologist, and a pediatric intensivist on the appropriate choice of ARM use in various clinical scenarios. They emphasized the benefits of H2 receptor antagonists (H2RAs) over PPIs, particularly in neonates and infants, where H2RAs offer a safer alternative due to their lower risk of adverse effects. The paper outlines the effective application of H2RAs in managing GERD, preventing stress ulcers, and treating drug-induced dyspepsia. It also provides guidelines for appropriate ARM use, stressing the need for careful patient evaluation to minimize the risk of unnecessary ARM use. Pediatricians also provided a view on the use of H2RAs beyond gastrointestinal indications, such as in urticaria, where they show promising clinical application when combined with H1-antihistamines. This paper offers valuable insights and recommendations for optimizing the use of ARM in pediatric practice. By highlighting the advantages of H2RAs and addressing the limitations and risks associated with PPIs, the paper aims to guide clinicians in making informed, evidence-based decisions. The goal is to improve clinical outcomes, promote the rational use of ARM, and enhance the quality of pediatric care.

We present an adolescent girl with a 1-day history of acute urinary retention and lower abdominal pain. She was admitted to the paediatric ward for ongoing treatment and investigations. Due to a myriad of factors including pain and anxiety, challenges posed included an incomplete initial abdominal and external genital examination. This case report highlights the importance of a focused history and performing an appropriate sensitive examination at the time of presentation. Furthermore, we explore the common causes of new onset urinary retention and unravel the case as it unfolds. We also highlight differential diagnoses (however, uncommon), which must be considered and not overlooked to avoid unnecessary investigations and to ensure timely management.

ObjectivesUTI is commonly encountered in children and can be the first manifestation of congenital anomalies of the kidneys and urinary tract (CAKUT).1 There are controversies surrounding diagnosis, imaging and management but imaging remains the central area of debate.2 The NICE guidelines for managing UTIs in under 16 years were published in August 2007 and updated in September 2017 and 2022.3 The objectives of the study were to analyse our current practice of ordering imaging in culture- positive UTIs in children under 16 years and to assess compliance with NICE guidelines (2017).MethodsA retrospective study was conducted at our trust on children under 16 years diagnosed with culture-positive UTI between January 2017 and January 2019. The first 75 children on the list were included;10 children with antenatal diagnosis of renal tract abnormalities or with urine culture showing mixed growth or bacterial growth less than 104 CFU were excluded. Data was collected from medical records. The imaging modality ordered was analysed against NICE recommendations. As per NICE guidelines, children were divided into three categories based on age and the imaging pathway was evaluated based on first, recurrent and/or atypical UTI.ResultsOut of the cohort of 65 patients, 48(73%) were male and 17(27%) were females. The age distribution of children showed that 5(8%) were under 6 months,25(38%) were 6 months-3 years and 35(54%) were over 3 years.Out of the total cohort 33 (51%) children had their first UTI,20 (31%) had recurrent UTI and 12 (18%) had atypical UTI. E. coli was the most common organism in urine culture in 57(87%) patients. Two patients had Proteus, 2 had Klebsiella and 1 each grew Pseudomonas, Enterococcus faecalis, Staphylococcus aureus and Citrobacter freundii in urine culture.The overall compliance of investigations was compared against NICE recommendations as shown in figure 1. Among 65 children, 41 had renal tract ultrasound of which, 27(66%) were requested as per guidelines and 14(34%) were not. DMSA was requested in 14 children:13(93%) were compliant and 1(7%) was non-compliant. MCUG was requested in 7 children: 4(57%) were compliant and 3(43%) were not.Abstract 6061 Figure 1Compliance of imaging ordered against NICE guidelinesConclusionE. coli was the most common organism grown in urine culture. Overall, compliance with NICE guidelines for DMSA requests was good but was poor when requesting USS/MCUG. Reiteration to staff to follow NICE guidelines and acknowledge the update in 2022 would help request imaging appropriately and avoid unnecessary investigations.ReferencesML Palacios Loro, Ramirez D, Álvarez F, Fernando Santos Rodríguez. Congenital anomalies of the kidney and urinary tract. A vision for the paediatrician. Anales de Pediatría (English Edition) [Internet]. 2015 Dec 1 [cited 2023 Oct 16];83(6):442.e1–5. Available from: https://www.analesdepediatria.org/en-congenital-anomalies-kidney-urinary-tract--articulo-S2341287915002811Kari JA, Kjell Tullus.Controversy in Urinary Tract Infection Management in Children: A Review of New Data and Subsequent Changes in Guidelines. Journal of Tropical Pediatrics [Internet]. 2013 Jun 28 [cited 2023 Oct 16];59(6):465–9. Available from: https://pubmed.ncbi.nlm.nih.gov/23812014.Recommendations:Urinary tract infection in under 16s:diagnosis and management | Guidance | NICE [Internet]. Nice.org.uk. NICE; 2022 [cited 2023 Oct 16]. Available from: https://www.nice.org.uk/guidance/ng224/chapter/Recommendations.

Worldwide, thousands of cases of multisystem inflammatory syndrome in children (MIS-C) have already been reported in children. Evidence regarding neonatal MIS-C is limited. We present the first case report of a neonate presenting within 48 hours of life with predominant abdominal signs mimicking surgical abdomen. Clinical picture comprised fever, multiorgan dysfunction (gastrointestinal, cardiorespiratory, hepatic and dermatological), positive inflammatory markers, high ferritin and high D-dimer levels. Cardiac enzyme N-terminal-pro-B-type natriuretic peptide as well as D-dimer levels were elevated. Blood, urine, stool and cerebrospinal fluid cultures were sterile. Positive anti-SARS-CoV-2 IgG in both the mother and the infant, along with an epidemiological evidence of maternal contact with COVID-19, clinched the diagnosis of MIS-C. Immunomodulatory drugs (intravenous immunoglobulin and systemic steroids) were administered and showed good clinical response. A high index of suspicion of MIS-C in critically ill neonates can improve outcomes.

Haemophagocytic lymphohistiocytosis (HLH) is an aggressive syndrome which has characteristic symptoms and laboratory findings. Infection is a common trigger of HLH. We report a 2700 g male infant with persistent fever, massive hepatosplenomegaly and severe thrombocytopaenia. Laboratory evidence of primary dengue infection was detected. Investigations revealed hypertriglyceridaemia, hypofibrinogenaemia, hyperferritinaemia and elevated soluble CD25. Bone marrow examination revealed haemophagocytes. The diagnostic criteria for HLH were fulfilled. A diagnosis of secondary HLH triggered by primary dengue infection was considered. Dexamethasone was initiated and continued for 8 weeks. He responded clinically with regression of hepatosplenomegaly, was afebrile and platelet counts normalised. Dengue‐associated HLH is often missed clinically as treating physicians focus more on the underlying infection and its treatment. In neonates, HLH should be considered as differential diagnosis of sepsis and other viral infections, particularly in situations of inappropriate response to standard management.

BackgroundWe evaluated the epidemiology of fluid balance (FB) over the first postnatal week and its impact on outcomes in a multi-center cohort of premature neonates from the AWAKEN study.MethodsRetrospective analysis of infants <36 weeks’ gestational age from the AWAKEN study (N = 1007). FB was defined by percentage of change from birth weight. Outcome: Mechanical ventilation (MV) at postnatal day 7.ResultsOne hundred and forty-nine (14.8%) were on MV at postnatal day 7. The median peak FB was 0% (IQR: −2.9, 2) and occurred on postnatal day 2 (IQR: 1,5). Multivariable models showed that the peak FB (aOR 1.14, 95% CI 1.10–1.19), lowest FB in first postnatal week (aOR 1.12, 95% CI 1.07–1.16), and FB on postnatal day 7 (aOR 1.10, 95% CI 1.06–1.13) were independently associated with MV on postnatal day 7. In a similar analysis, a negative FB at postnatal day 7 protected against the need for MV at postnatal day 7 (aOR 0.21, 95% CI 0.12–0.35).ConclusionsPositive peak FB during the first postnatal week and more positive FB on postnatal day 7 were independently associated with MV at postnatal day 7. Those with a negative FB at postnatal day 7 were less likely to require MV.