Establishing a deanery teaching programme for trainees sitting the MRCPCH clinical examination.

Objectives MRCPCH is an essential qualification that all paediatric trainees in the UK must obtain to progress with their specialty training. In August 2009 a structured clinical teaching programme was initiated in the West of Scotland deanery to provide teaching in the clinical examination curriculum, the structure and examination standards. Design The training programme runs three times a year, commencing two months prior to each exam.

Multifocal multi-organ ischaemia and infarction in a preterm baby due to maternal intravenous cocaine use: a case report.

Introduction: Although the adverse effects of cocaine use in pregnancy are well recognised, we believe this case highlights the importance of considering the route of administration, and suggests the possibility of multifocal damage relating to intravenous use.

Case Presentation: A Caucasian female baby of 29-weeks' gestation was spontaneously delivered and subsequently developed multi-organ failure considered unrelated to simple prematurity. Intensive care was re-orientated following the development of massive intraventricular haemorrhage.

Multifocal multi-organ ischaemia and infarction in a preterm baby due to maternal intravenous cocaine use: a case report.

Introduction: Although the adverse effects of cocaine use in pregnancy are well recognised, we believe this case highlights the importance of considering the route of administration, and suggests the possibility of multifocal damage relating to intravenous use.

Case Presentation: A Caucasian female baby of 29-weeks' gestation was spontaneously delivered and subsequently developed multi-organ failure considered unrelated to simple prematurity. Intensive care was re-orientated following the development of massive intraventricular haemorrhage.

Setting up a neonatal transport service: air transport.

Air transport is an integral part of any system that provides neonatal care in the developed world. To ensure that this is developed in an efficient and appropriate manner a prospective analysis is required to allow a multidisciplinary team to progress a project aimed at providing appropriate staff with adequate training using equipment that has satisfied all regulatory bodies. This article highlights the difficulties in achieving this, reflecting on the way in which established air transport teams have overcome many of the difficulties.

Determination of the prevalence of drug misuse by meconium analysis.

In a pilot study to determine the local prevalence of maternal drug misuse, meconium from 400 infants was analysed for metabolites of eight controlled drugs. Cannabinoids were found in 13.25%, cocaine in 2.

Fit to fly: practical challenges in neonatal transfers by air.

Air transport of infants in incubators should be undertaken in a manner that is safe for both staff and infant and satisfies all directives by appropriate regulatory bodies. In Scotland during the last two years, certification of an infant incubator system for use in both rotary and fixed wing aircraft has been accomplished. This is a report of the issues addressed during this project, which will be common to all neonatal transport services intending to develop air transport capability.

A randomised controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome.

Background: The incidence of neonatal abstinence syndrome (NAS) has increased 10-fold over the last decade in Glasgow. In the Princess Royal Maternity Hospital, it now accounts for 17% of special care baby unit (SCBU) admissions.

Objective: To compare opiate replacement therapy (morphine sulphate) with the present standard treatment (phenobarbitone) for management of NAS.

Optimising neonatal transfer.

Services for neonatal intensive care in the United Kingdom have evolved in a largely unplanned fashion. Units of different sizes provide various amounts of intensive care, and, with a few exceptions, there is little or no formal regional or subregional organisation. Chronic underresourcing and the salvaging of ever more complex infants have resulted in tertiary neonatal intensive care units operating at full capacity most of the time, a situation compounded by a chronic national shortage of nursing staff.

Early perfluorodecalin lung distension in infants with congenital diaphragmatic hernia.

Background/purpose: Pulmonary hypoplasia contributes to mortality in infants with severe congenital diaphragmatic hernia (CDH). Accelerated postnatal lung growth with perfluorocarbon lung distension has been demonstrated in animals. The authors present a study measuring perfluorodecalin distension in neonates with severe CDH on extracorporeal membrane oxygenation (ECMO) support.

Paediatricians' perception of the use of extracorporeal membrane oxygenation to treat meconium aspiration syndrome.

This questionnaire study was designed to determine how consultant paediatricians perceived the value of extracorporeal membrane oxygenation (ECMO) in the treatment of meconium aspiration syndrome (MAS). A significant number believed that the survival of infants with MAS who received ECMO was lower than reported. Early discussion with an ECMO centre will ensure appropriate timing of referral.

Endothelin-1 levels in infants with pulmonary hypertension receiving extracorporeal membrane oxygenation.

We studied the possibility of an etiological role for endothelin-1 (ET-1) in the development of persistent pulmonary hypertension of the newborn (PPHN). Ten infants with severe PPHN requiring extracorporeal membrane oxygenation (ECMO) were studied. Pre and post pulmonary blood samples were obtained on commencing ECMO and on recovery.

Bone marrow gene transfer in three patients with adenosine deaminase deficiency.

Adenosine deaminase (ADA) deficiency results in severe combined immune deficiency disease (SCID), which is fatal without treatment. Allogeneic bone marrow transplantation (BMT) is the treatment of choice if an HLA-identical sibling bone marrow donor is available, resulting in almost 100% cure rate. BMT-related mortality is high in patients lacking such a donor.

Role of ECMO in the treatment of respiratory syncytial virus bronchiolitis: a collaborative report.

Aim: To report the collaborative experience of extracorporeal membrane oxygenation (ECMO) in the treatment of respiratory syncytial virus (RSV) bronchiolitis between April 1989 and January 1995.

Methods: The medical records of patients with confirmed RSV bronchiolitis referred to three centres (Leicester, Glasgow, and Great Ormond Street) were reviewed.

Results: Twenty four infants were identified.

Randomised trial of continuous nasogastric, bolus nasogastric, and transpyloric feeding in infants of birth weight under 1400 g.

Forty three infants under 1400 g were fed by a bolus nasogastric, continuous nasogastric, or transpyloric route. There were more complications with transpyloric feeding and no identifiable benefits in the growth rate, oral energy input, or chosen biochemical indices of nutrition. Bolus or continuous nasogastric feeds rather than transpyloric are better routine methods in infants of low birth weight.

Genetic aspects of admissions to a paediatric intensive care unit.

Of 821 consecutive admissions to a paediatric intensive care unit, 47 (5.7%) were for chromosomal or monogenic disorders. These patients had more readmissions, longer mean stays, and a higher mortality rate than the group as a whole.

Nephroblastoma presenting with acute hepatic encephalopathy.

A 3 year old girl presented with Budd-Chiari syndrome of acute onset, and hepatic encephalopathy secondary to intravascular extension of a Wilms' tumour shown on echocardiography. After a period of intensive medical treatment the tumour was removed, cardiopulmonary bypass with hypothermic circulatory arrest being necessary. Her hepatic failure resolved and she made a complete neurological recovery.