Clinical Service Line 10 - Neonatology, Paediatrics, Paediatric wards, NICU/SCBU

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    Thyroid disorders in neonates: A practical approach to congenital hypothyroidism and thyrotoxicosis
    (2023) Nallagonda, Srinivas; Inusa, Amile; Gupta, Rohit; Nallagonda, Madhavi
    Congenital hypothyroidism is one of the most common causes of preventable intellectual disability in the UK and worldwide. Early diagnosis is critical to allow for early intervention. At present, 1 in 2000 to 1 in 3000 babies born in the UK have congenital hypothyroidism. Of these, most will not display any clinical manifestations or symptoms in the first few weeks of life. In short, babies will develop intellectual disability if they go undiagnosed. It is therefore no surprise that the day 5 blood spot is essential for good outcomes and harm reduction. Diagnosis of thyroid disorder is based on measuring the thyroid hormones and thyroid stimulating hormone levels. The most common cause of congenital hypothyroidism is an abnormality in thyroid gland development (dysgenesis) but it may also be the result of a defect in thyroid hormonogenesis or may be temporary as a result of maternal medications passing through the placenta, maternal blocking antibodies or iodine excess or deficiency. Rarely, it is the result of pituitary or hypothalamic abnormality when it is called central or secondary/tertiary hypothyroidism. This short article offers practical advice on how to diagnose and treat congenital hypothyroidism and how to interpret the results of available biochemical tests.
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    Children Lost to Follow Up from Outpatient Clinics- how can we Improve?
    (2023) Niranjan, Usha; Church, Sarah; Davey, Nicola
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    721 An audit on management of anaphylaxis in Bedford hospital
    (2023) Ali, Alaa; Sabah, Noor; Noorani, Tabrez
    Abstract Objective The growing prevalence of anaphylaxis reported worldwide, including in the UK1 have heightened the importance of managing this potentially fatal condition. The outcome of the recent initiative of the UK anaphylaxis Registry will be a useful contribution to help improve services for our allergy patients and help guide public policy.2 The objective of this audit is to examine the current practices for managing paediatric patients experiencing anaphylaxis in the Paediatrics Emergency Department (ED) and Children’s Assessment Unit (CAU) and to determine if they align with NICE and local guidelines. Methods We analysed the medical records of patients who presented to ED and CAU in Bedford hospital from over 3 years period. These patients were identified using the keywords ‘anaphylaxis’ and ‘allergic reaction’ in the coding system. The data was gathered by reviewing their notes using a proforma designed for this purpose. Results A total of 35 cases were evaluated, with 14 patients meeting the audit criteria. The patients ranged in age from 1 to 14 years old, with 8 of them being male. The most common symptoms were breathing difficulties and hives, seen in 11 out of 14 patients. Lip swelling, itching, and gastrointestinal symptoms were reported by 8, 6, and 5 patients respectively. Other symptoms seen less frequently included wheezing, flushing, choking, drooling, lip tingling, low oxygen saturation, lethargy, and loss of consciousness. An identifiable allergen trigger was reported in every case, with nuts or nut-containing foods being the trigger in 9 out of 14 patients and cow’s milk protein in 2. Adrenaline was given to 10 patients, 7 received oral prednisolone or hydrocortisone, 11 were given antihistamines, and 2 received salbutamol. Tryptase was only done in 1 case. 9 patients were referred to an allergy clinic, and 7 received adrenaline auto-injector training. However, all cases lacked documentation of avoidance advice and a written management plan. Conclusion The audit highlights the need for improved recognition, diagnosis, and management of anaphylaxis, as well as more thorough documentation, particularly in relation to safety information provided at discharge. To address these findings, a checklist was developed and piloted to be completed for all patients with anaphylaxis prior to discharge. This checklist will be disseminated to the staff in the ED paediatrics departments. Teaching sessions will be conducted to emphasise the importance of appropriate management of anaphylaxis. A re-audit will be conducted in a year to complete the audit cycle.