Community-acquired pneumonia in children: what's new?

The community-acquired pneumonia in children guidelines have just been updated with new evidence on incidence, aetiology and management. This guidance should improve patient care.

Persistent individual tracking within overall improvement in HbA1c in a UK paediatric diabetes clinic over 15 years.

Introduction: There is some evidence of long-term tracking of HbA(1c) levels within diabetes centres, but little evidence of individual tracking.

Methods: HbA(1c) levels of children in the clinic over a period of 15 years were retrieved from the clinical chemistry laboratory information system. We measured the correlation of HbA(1c) between years (Spearman and Pearson rank correlation), as well as the relationship of HbA(1c) with age and the change over time in the clinic.

Rectal biopsy for Hirschsprung's disease--are we performing too many?

Background: Rectal biopsy is considered the gold standard for the diagnosis of Hirschsprung's disease. The aim of this study was to evaluate the outcome of rectal biopsies performed in our institution, and to determine whether we are performing an adequate number of biopsies in patients presenting with features suggestive of this disease.

Methods: A retrospective analysis was conducted of patients who underwent rectal biopsy to exclude Hirschsprung's disease over a seven year period between 2000 and 2006.

A novel ARX phenotype: rapid neurodegeneration with Ohtahara syndrome and a dyskinetic movement disorder.

ARX mutations are associated with variable clinical phenotypes. We report a new neurodegenerative phenotype associated with a known ARX mutation and causing early abnormal neurodevelopment, a complex movement disorder, and early infantile epileptic encephalopathy with a suppression-burst pattern (Ohtahara syndrome). A male infant presented at age 5 months with a dyskinetic movement disorder, which was initially diagnosed as infantile spasms.

Case report of paediatric oxalate urolithiasis and a review of enteric hyperoxaluria.

The formation of renal calculi secondary to enteric hyperoxaluria is rare in the paediatric population. We present the case of an 8-year-old boy who had short bowel syndrome resulting in enteric hyperoxaluria which led to the development of urolithiasis and bilateral ureteric strictures, both of which resolved with medical management. We also review the literature on enteric hyperoxaluria.

Pre-sternal mass with a congenital sternal defect: a rare presentation.

Anterior chest wall and anterior mediastinal infections are very rare in children with no predisposing thoracic surgery. Congenital sternal defects occur as a result of incomplete ossification of the sternal bone, and show a wide range of severity. We present the case of a 15-month-old boy who presented to the A&E department with an anterior chest-wall mass.

An unusual variant of choledochal cyst: a case report.

Introduction: Choledochal cyst is an uncommon congenital disease of the biliary tract in the UK. There are five main types of choledochal cyst with several recognised sub-types. However, occasional variants do occur.

Longitudinal screening of serum lipids in children and adolescents with Type 1 diabetes in a UK clinic population.

Aims: To determine the prevalence of abnormal lipid levels in a large group of children and adolescents with Type 1 diabetes and to examine the changes longitudinally. In addition, to study the relationships of any lipid abnormalities to glycaemic control, age and duration of diabetes.

Methods: Non-fasting blood samples were taken annually from all the patients in the Oxford Children's diabetes clinic and total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, triglycerides (TG) and glycated haemoglobin (HbA(1c)) measured over a period of 8 years.

Management of congenital cystic adenomatous malformations of the lung.

Congenital cystic adenomatous malformation of the lung (CCAM) is a rare lung lesion easily diagnosed on prenatal scan. The pathology of fetal lesions differs from postnatal lesion, hence the need for separate classifications during the different stages of development. Fetuses with CCAMs and hydrops have a poor prognosis and may be candidates for prenatal intervention where available.

The influence of twinning on cardiac development.

The risk for a cardiac anomaly in a twin pregnancy is increased, particularly in monochorionic twins. This is relevant in terms of fetal diagnosis as well as for the management of the pregnancy; there are also implications for the neonatal period and possibly beyond. The risk for a cardiac abnormality depends on the type of monochorionic twin as determined by the timing of embryonic division.

Antibiotics for community-acquired pneumonia in children: is intravenous delivery necessary?

Evaluation of: Atkinson M, Lakhanpaul M, Smyth A et al. A multicentre randomised controlled equivalence trial comparing oral amoxicillin and intravenous benzyl penicillin for community acquired pneumonia in children PIVOT Trial. Thorax DOI: 10.

Measurement of intracranial pressure in children: a critical review of current methods.

Assessment of intracranial pressure (ICP) is essential in the management of acute intracranial catastrophe to limit or actively reduce ICP. This article provides background information and reviews the current literature on methods of measuring ICP in children. Indications for ICP measurement are described for children with traumatic brain injury, shunt insertion or malfunction, arachnoid cyst, craniosynostosis, and prematurity.

An unusual cause of a superior mediastinal mass in an infant.

Tuberculosis has not been reported to be a cause of mediastinal masses in previous case series of mediastinal masses in children. We report the case of a 7-month-old infant with a superior mediastinal mass extending into the right chest, who was referred to the paediatric surgical team for biopsy and further management. Clinical and radiological findings were suggestive of a malignancy.

How should we manage empyema: antibiotics alone, fibrinolytics, or primary video-assisted thoracoscopic surgery (VATS)?

Empyema is a well-recognized complication of pneumonia and its prevalence is increasing in the childhood population. The management of these patients requires a strategy for diagnosis and treatment that results in prompt resolution of infection and discharge with minimal morbidity. Traditionally conservative treatment has been the standard with insertion of a chest drain and intravenous antibiotics and, for those who fail to respond, an open thoracotomy and formal decortication.