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Recent Advances in Paediatrics 26
Ian Maconochie
CHAPTER 1:
Childhood tuberculosis: new tools and remaining challenges
Background
How do children get TB?
Pathophysiology of TB in children
Diagnostic challenges in the absence of bacteriological confirmation
Latest progress in diagnostics
GeneXpert MTB/RIF assay
Immuno-diagnostics: in vitro IGRAs
Special consideration in the context of HIV infection
Special considerations for multidrug-resistant TB in children
Treatment regimen for childhood TB
General considerations
Specific recommendations
Corticosteroids
New anti-TB drugs
Treatment and prevention of MDR-TB
Prevention of childhood TB
Contact tracing and prophylaxis
Vaccines
BCG vaccine
New TB vaccines
Conclusion
CHAPTER 2:
Medical education theory in practice
Introduction
Reflective practice
Leadership learning and quality improvement
Paired learning
Simulation
Learning with peers
Peer-led teaching
Supervision and mentoring
Conclusion
CHAPTER 3:
Hypertonicity in childhood: concepts and medical management
Introduction
Definitions of childhood hypertonicity
What causes high tone? The pathophysiology of hypertonicity
The pathophysiology of hypertonicity in cerebral palsy
What to consider when treating hypertonicity
Medications for the treatment of hypertonicity
Botulinum toxin
Neurosurgical treatments for childhood hypertonicity
Intrathecal baclofen
Deep brain stimulation
Selective dorsal rhizotomy
Which neurosurgical treatment should be used?
Stem cell therapy and other future therapies
CHAPTER 4:
Advances in burns treatment
Epidemiology
United Kingdom and worldwide
Age, development and mechanism
Emerging trends in burn injury mechanisms
NAI and neglect
Initial management
First aid
Fluid resuscitation and ‘permissive hypovolaemia’
Assessment of burn severity
Area
Depth
Burn networks and referrals
Dressings
Autologous cell delivery systems
Antibacterial preparations and silver
Surgical management
Early cleaning and debridement
Split skin grafting
Reconstruction
Inflammation, infection and toxic shock
The systemic inflammatory response syndrome and hypermetabolic response
Colonisation, burn wound erythema, infection and sepsis
Prophylactic antibiotics
Toxic shock syndrome (TSS)
Rehabilitation
Scar management
Psychology
CHAPTER 5:
Initial investigation of inherited metabolic disease
Introduction
History
Examination
Investigation
Commonly used investigations
Lactate
Ammonia
Acylcarnitines
Urine organic acids
Investigation of lysosomal storage disease – glycosaminoglycans, oligosaccharides, vacuolated lymphocytes and lysosomal enzymes
Very long chain fatty acids
Transferrin isoelectric focussing
Postmortem investigations
Common acute clinical scenarios
Acute encephalopathy
Hypoglycaemia
Acidosis
Initial management
CHAPTER 6:
Practical aspects of immunisation
Introduction
Factors affecting the uptake of childhood immunisation
Adverse events following immunisation
Neonatal BCG: who, why, when and where?
Recent changes in the UK childhood immunisation programme
Meningococcus C
Meningococcus B
Seasonal influenza
Rotavirus
CONCLUSION
CHAPTER 7:
Vitamin D deficiency in children
Vitamin D biology
Pathophysiology
Definition of vitamin D deficiency
Risk factors for vitamin D deficiency
Inadequate sunlight exposure
Impaired vitamin D absorption or metabolism
Other risk factors
Epidemiology
Clinical features
Investigations
Treatment
Vitamin D deficiency and fracture risk in children
Vitamin D status and bone mass accrual during childhood
Proposed extraskeletal roles of vitamin D
Prevention of vitamin D deficiency
CHAPTER 8:
Comparing regional infant death rates in the United Kingdom
Introduction
Definitions
Where to find data
Understanding variation in rates of early childhood mortality in the United Kingdom
Important considerations when interpreting early childhood mortality data
Hospital or geographical area
Defining the cohort – gestation or birth weight?
Socio-economic differences
Ethnicity
Variation in definition and registration practices
Interpreting early childhood mortality rates
Cause specific mortality
Trends in early childhood mortality rates in the United Kingdom
Conclusion
CHAPTER 9:
Triage in emergency care: concepts and context
Triage tools
Examples of commonly used tools
Training, experience and level of staff using the tool
Contextual or linked processes
Other linked processes
How they are linked (and how the lines get blurred)
Models for contexts
Model 1
What does this look like?
Model 2
What does this look like?
Model 3
Model 4
Model 5
What does this look like?
Model 6
CONCLUSION
CHAPTER 10:
Therapeutic use of hypothermia (32–34°C) in critically ill or injured children
Introduction
Historical uses of hypothermia
Scientific basis for use of hypothermia for neuroprotection
Avoidance of hyperthermia
Clinical applications of TH
Overview
Post-cardiac arrest
Traumatic brain injury
Status epilepticus
Spinal cord injury and cerebral stroke
Systemic inflammatory response syndrome and extracorporeal membrane oxygenation
Cardiac arrhythmias post congenital heart surgery
Acute liver failure and hyperammonaemic metabolic crisis
Neonatal surgery for necrotising enterocolitis
Practical considerations
‘Dose’ of TH
Induction
Maintenance
Rewarming
Methods of cooling
Risks and monitoring during TH
Neurological prognostication after cerebral hypoxic ischaemia
Conclusion
CHAPTER 11:
Antenatal hydronephrosis: an update on postnatal management
Introduction
What are the causes of ANH?
Vesicoureteric reflux
Obstructive uropathy
How is ANH classified?
Grading systems
What degree of dilatation of the fetal renal pelvis should be considered clinically relevant?
What postnatal imaging should be performed in an infant with ANH?
What is the role of antibiotic prophylaxis?
How should suspected PUJ and VUJ dysfunction be managed?
What future developments are likely?
Assessment of the role of antibiotics in postnatal management of ANH
Urine proteomics
CONCLUSION
CHAPTER 12:
Noninvasive approach to neonatal care
Introduction
Noninvasive ventilation
Stabilisation in the delivery room
Transfer and admission to NICU
Early days
Making the effects last
Antibiotic use on NICU
Management of possible EOS impacts on LOS
Prevention is better than cure
Using antibiotics carefully throughout the inpatient stay
Enteral feeds
Other noninterventional techniques and benefits
Developmental care (DC) approaches
Bloods and investigations
Pain management
Empower your staff to advocate for the babies
Conclusion
INDEX
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