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Background Urinary tract infections are common and require prompt treatment. Objective To examine the resistance rates of co-amoxiclav in children with urinary tract infection and whether antimicrobial resistance is influenced by other variables. Methods The records and antibiotic susceptibility data of 209 patients admitted with symptomatic urinary tract infection between January 2018 and December 2019 were reviewed. Results We examined 209 patients [mean (SD) age 23.73 (32.86) months], of whom 176 (84.2%) had first urinary tract infection. Escherichia coli was isolated in 190 (90.1%). Uropathogens were sensitive to co-amoxiclav in 47.8% of patients and gentamicin in 95.2%. Combined co-amoxiclav with gentamicin demonstrated antimicrobial sensitivity in 96.2%. Antimicrobial resistance was associated with longer hospital stay (p-value p-value 0.001). No link was observed between antimicrobial resistance and atypical urinary tract infection. Conclusion Approximately half of children in this cohort had urinary tract infection due to uropathogens resistant to co-amoxiclav. Co-amoxiclav resistance is associate with recurrent infections and longer hospital stays. A combination of co-amoxiclav and gentamicin demonstrates > 96% susceptibility.

Influenza is generally a self-limiting disease (1), however, complications can occur (2). We examined whether there is link between influenza strains in children and length of hospital stay (LOS), transfer to ICU, mortality, secondary bacterial infection (SBI) or peripheral blood tests. We studied141 patients attended our hospital between November 2017 and March 2018; influenza A was reported in 80 (56.7%), influenza B in 60 (42.6%) and both strains in one. Mean (SD) age was 5.12 (4.30) years. Statistically, patients were divided into two groups (influenza A and influenza B). Admission to paediatric ward was required in 91 patients (64.54%), of whom two required transfer to ICU (2.2%). No mortality was documented. Mean (SD) LOS was 2.33 (1.92) days, with no link between LOS and influenza viral strains (p value 0.35). Of 141 patients, 111 underwent blood tests. Of 111 patients, the majority had normal total WBC [72 patients (64.9%)] and neutrophil values [80 (72.1%)]. More than half had normal lymphocyte [61 patients (55.0%)] and monocyte values [64 (57.7%)]. However, total WBC, neutrophil, lymphocyte and monocyte values were elevated in 9 (8.1%), 19 (17.1%),two(1.8%) and 47 (42.3%) patients, respectively. Total WBC, neutrophil and lymphocyte values were lower than the reference range in 30 (27.0%), 12 (10.8%) and 48 (43.2%) patients, respectively. Total WBC, neutrophil, lymphocyte or monocyte values did not differ between the groups (p value 0.48, 0.52, 0.71 and 0.38, respectively). Combined abnormal WBC differentials were uncommon [5 of 111 patients (4.50%)]. In terms of predicting influenza strains, neutrophil lymphocyte ratio (NLR) and monocyte lymphocyte ratio (MLR) have low sensitivity, with area under the ROC curve 0.42 and 0.53, respectively. Mean (SD) C-reactive protein (CRP) value was 14.45 (10.12) mg/L, with no difference between the groups (p value 0.52). No organisms were detected in 79 patients who underwent peripheral blood culture. In conclusion, influenza can occur with normal WBC and CRP values. NLR or MLR has no role in predicting influenza serotypes. In this group of patients, the vast majority did not require transfer to ICU. Moreover, there is no link between influenza viral strains and LOS, mortality or SBI References 1. Mancinelli L, Onori M, Concato C, et al. Clinical features of children hospitalized with influenza A and B infections during the 2012–2013 influenza season in Italy. BMC Infect Dis. 2016 Jan 8;16:6. doi: 10.1186/s12879–015–1333-x Rothberg MB, Haessler SD. Complications of seasonal and pandemic influenza. Crit Care Med 2010; 38:e91.

Bacterial meningitis is characterized by inflammation of the meninges covering the brain. It is a life-threatening illness, if untreated. The aim of this study was to examine whether blood tests including C-reactive protein (CRP) and full blood count (FBC) predict bacterial meningitis in children. We also examined the relationship between cerebrospinal fluid (CSF) tests including gram stain, culture and polymerase chain reaction (PCR) and blood tests such as culture and PCR results. We studied 11 patients admitted with bacterial meningitis in the Paediatric wards, National Children’s Hospital, Dublin, Northern Ireland (2012–2016). The mean age was 10.7 (SD, 14.7) months. In this group of patients, 5 (45.5%) had leucocytosis, 7 (63.6%) experienced neutrophilia and 1 (9.1%) had both leukopenia and neutropenia. C-reactive protein (CRP) value of less than 1 mg/L was found in 2 patients (18.2%). No link was found between CSF gram stain and CSF culture (p value 0.66) or CSF PCR results (p value 0.75). Meningitis should be investigated and treated if clinically suspected, regardless of CRP values or peripheral blood results.

Down syndrome (DS) is one of the most common chromosomal abnormalities with an incidence of 1:444 births.1 Ireland has the highest prevalence of DS in Europe, which may be partially explained by the legislation against termination of pregnancy.1 Individuals with DS are at higher risk of developing coeliac disease (CD) compared with the general population (5%–10% vs 1%).2 CD can be difficult to diagnose due to the frequency of asymptomatic cases, and it can be particularly difficult to identify clinically in children with DS in whom short stature, abdominal distension and constipation are common clinical features. The European Society …

Base deficit and serum lactate concentrations may be important prognostic indicators in preterm infants. We sought to (1) determine the relationship between day 1 serum lactate values and base deficit and (2) determine the relationship between day 1 biochemical parameters and adverse outcome in preterm infants

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory disorder of the kidney. Infiltration to lung and liver can occur. We present a rare complication of locally invasive XGP extending beyond the diaphragm to the lung to cause bronchiectasis in an adolescent girl with chronic productive cough, weight loss and no urinary symptoms. The patient underwent open left radical nephrectomy, where it was noted that the left kidney lay very high with significant perinephric inflammation and was densely adherent to the diaphragm and partially adherent to the spleen. XGP was confirmed on histology.

The risk of developing coeliac disease (CD) is higher in Turner syndrome (TS) than the general population1 and screening has been recommended in asymptomatic individuals known to have an increased risk of developing the disease.2 In light of this recommendation, we set out to determine the prevalence of CD in Irish girls with TS. The presence of CD was assessed by measuring serum immunoglobulin (Ig)A and IgA antitissue transglutaminase (IgA-tTG) values. IgG-tTG values were not measured because all participants proved to have …

Aim To describe bone mineral density at the lumbar spine in a group of girls with Turner's syndrome and determine its relation to pubertal development. Methods Girls with Turner's syndrome aged over 12 years were invited to participate in the study. All participants underwent auxology, pubertal assessment and laboratory evaluation. Bone mineral density was estimated by dual-energy X-ray absorptiometry. Bone mineral apparent density was then calculated, and the results were compared with age-matched Dutch reference data. Results We studied 32 girls with Turner's syndrome, mean (SD) [range] age 16.7 (2.6) [12.4–20.2] years and height 148.3 (9.0) [126–159.2] cm. Bone mineral apparent density lumbar spine values were −0.87 SD, significantly lower than in the reference population (p

Department of Paediatrics, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland Coeliac disease (CD) is an immune reaction to gluten in genetically predisposed subjects. CD is likely to affect approximately 1% of the population of England [1]. The age of presentation is influenced by the age of introduction of gluten into the diet. CD may present as a large variety of non-specific signs and symptoms. Children with CD may experience unexplained poor growth following the introduction of gluten, delay puberty, abnormal stools and constipation. General irritability, chronic abdominal pain, abnormal liver biochemistry, abdominal distension and buttock wasting have been reported. CD should be considered in children presented with iron deficiency anaemia, growth failure with or without gastrointestinal symptoms. Patients with CD may experience low bone mineral density [2], but similar health-related quality of life as their peers without CD [3]. However individuals with CD may exhibit no symptoms. Certain individuals are at an increased risk; such as patients with type 1 diabetes mellitus, Down’s syndrome and Turner’s syndrome, for example, and presymptomatic screening is advised [4]. Diagnosis can be confirmed by flat mucosa on jejunal biopsy followed by the resolution of symptoms and catch up growth upon gluten withdrawal. Diagnostic serological tests have been developed. These’s include IgA anti-tissue transglutaminase (IgA-tTG) and antiendomysium antibody (EMA) values. It is important to measure serum IgA level and IgG-tTG values should be considered in those with low IgA levels. In previous study, biopsyproven CD and positive EMA were reported in 60% of those with elevated IgA-tTG levels above the reference range, whereas biopsy-proven CD was reported in all patients with positive EMA [5]. European Society for Paediatric Gastroenterology, Hepatology and Nutrition working group suggested that typing for HLA-DQ2 and HLA-DQ8 can be helpful where there is uncertain diagnosis of CD; such as cases with negative CD antibodies and mild changes on biopsy or with strong clinical suspicion, highly specific CD antibodies and biopsies are not going to be performed, for example [4]. Monitoring for CD is required in children with unexplained poor growth, delayed puberty or unexplained gastrointestinal symptoms and screening in asymptomatic individuals who are at an increased risk is advised.

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic inflammatory disorder of the kidney. Infiltration to lung and liver can occur. We present a rare complication of locally invasive XGP extending beyond the diaphragm to the lung to cause bronchiectasis in an adolescent girl with chronic productive cough, weight loss and no urinary symptoms. The patient underwent open left radical nephrectomy, where it was noted that the left kidney lay very high with significant perinephric inflammation and was densely adherent to the diaphragm and partially adherent to the spleen. XGP was confirmed on histology.

Congenital Pulmonary Malformations (CPMs) are a group of rare lung abnormalities affecting the airways, parenchyma, and vasculature. They represent a spectrum of abnormal development rather than discrete pathological entities. They are caused by aberrant embryological lung development which occurs at different stages of intrauterine life.

Low bone mineral density (BMD) in patients with Turner syndrome (TS) has been reported in a considerable number of previous studies. Cortical and trabecular bone have been involved. Osteoporosis can be overdiagnosed in TS patients with a short stature unless BMD measurements are adjusted for body size. Optimization of bone health in girls with TS requires a healthy active lifestyle, including adequate calcium, vitamin D, and hormonal replacement therapy, according to consensus guidelines.

Background To examine the blood glucose profile and the relationship between blood glucose levels and neurodevelopmental outcome in term infants with hypoxic-ischaemic encephalopathy. Methods Blood glucose values within 72 hours of birth were collected from 52 term infants with hypoxic-ischaemic encephalopathy. Hypoglycaemia [< 46.8 mg/dL (2.6 mmol/L)] and hyperglycaemia [> 150 mg/dL (8.3 mmol/L)] were correlated to neurodevelopmental outcome at 24 months of age. Results Four fifths of the 468 blood samples were in the normoglycaemic range (392/468:83.8%). Of the remaining 76 samples, 51.3% were in the hypoglycaemic range and (48.7%) were hyperglycaemic. A quarter of the hypoglycaemic samples (28.2%:11/39) and a third of the hyperglycaemic samples (32.4%:12/37) were recorded within the first 30 minutes of life. Mean (SD) blood glucose values did not differ between infants with normal and abnormal outcomes [4.89(2.28) mmol/L and 5.02(2.35) mmol/L, p value = 0.15] respectively. In term infants with hypoxic-ischaemic encephalopathy, early hypoglycaemia (between 0-6 hours of life) was associated with adverse outcome at 24 months of age [OR = 5.8, CI = 1.04-32)]. On multivariate analysis to adjust for grade of HIE this association was not statistically significant. Late hypoglycaemia (6-72 hours of life) was not associated with abnormal outcome [OR = 0.22, CI (0.04-1.14)]. The occurrence of hyperglycaemia was not associated with adverse outcome. Conclusion During the first 72 hours of life, blood glucose profile in infants with hypoxic-ischaemic encephalopathy varies widely despite a management protocol. Early hypoglycaemia (0-6 hours of life) was associated with severe HIE, and thereby; adverse outcome.

We investigated pCO(2) patterns and the relationship between pCO(2) levels and neurodevelopmental outcome in term infants with hypoxic-ischemic encephalopathy. Blood gases during the first 72 hours of life were collected from 52 infants with hypoxic-ischemic encephalopathy. Moderate hypocapnia (pCO(2)3.3 kPa), severe hypocapnia (pCO(2)2.6 kPa), and hypercapnia (pCO(2)6.6 kPa) were correlated to neurodevelopmental outcome at 24 months. Normocapnia was documented in 416/551 (75.5%) of samples and was present during the entire 72 hours in only 6 out of 52 infants. Mean (standard deviation) pCO(2) values did not differ between infants with normal and abnormal outcomes: 5.43 (2.4) and 5.41 (2.03), respectively. There was no significant association between moderate hypocapnia, severe hypocapnia, or hypercapnia and adverse outcome (odds ratio [OR] = 1.84, 95% confidence interval [CI] = 0.49 to 6.89; OR = 3.16, CI = 0.14 to 28.45; and OR = 1.07, CI = 0.24 to 5.45, respectively). In conclusion, only one in nine newborns had normocapnia throughout the first 72 hours. Severe hypocapnia was rare and occurred only in ventilated babies. Hypercapnia and hypocapnia in infants with hypoxic-ischemic encephalopathy during the first 72 hours of life were not associated with adverse outcome.

A previously healthy 11-year-old girl presented with 2-week history of cough not responding to oral amoxicillin given by her general practitioner. Chest x-ray showed small dense lesion posterior to the left cardiac shadow, figure 1A. This progressed to right upper lobe consolidation two weeks later, figure 1B. She developed low-grade fever but remained otherwise clinically well. Chest CT showed multiple bilateral round infiltrates in the mid and lower lung fields, with some …

A previously healthy 6-year-old boy presented with a 2-week history of vague pain in his abdomen, arm, neck and legs, which became more localised to the right side of the neck and right tibial plateau. Over the 6 days prior to admission, nocturnal bone pain was recorded. He was also lethargic, irritable and felt warm; however, temperature >37.7°C was not documented. Intermittent limping was reported. Physical examination was unremarkable, apart from exquisite tenderness on right tibial tuberosity and severe neck …

Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17/25 (68%) were trained and 13/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2/13 (15%) of children. Non-medical grade monitors were in use by 10/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge.

Acute urinary tract infections are common in children. Our aim was to establish whether peripheral blood tests correlate with urinary culture. We also examined the relationship between peripheral blood results and the length of stay (LOS) in children and adolescents with UTI. We studied 135 patients admitted with UTI, mean (SD) age 3.0 (4.1) years. Of these 135 patients, 16 (11.9%) had combined normal serum WCC, normal neutrophil count and CRP5 mg/L. In this group of patients, there was no significant association between LOS and serum WCC, serum neutrophil values, E. coli infection or CRP values (p value 0.51, 0.98, 0.87, 0.82, respectively).

This study investigates attitudes of parents and staff to medical students on paediatric wards in a Dublin teaching hospital. We invited 100 parents of patients and 30 staff involved in the care of children on the paediatric wards to participate. The majority of parents agreed or strongly agreed that they would be happy for a student to interview them (n = 87; (87%)), interview their child (80%) or examine their child (74%). Of 30 staff, 12 (40%) staff agreed that the presence of medical students on the ward increased their job satisfaction, 13 (43%) agreed or strongly agreed that medical student presence encouraged them to keep up to date with recent medical developments and 6 (20%) felt that it increased the quality of patient care. Attitudes of both parents and staff to medical students on paediatric wards are positive with both emphasising the need for professional behaviour.