Archives of Disease in Childhood - Education and Practice current issue

[Best practice] Red blood cell transfusions in acute paediatrics

Morley, S L — 2009-05-21

Red blood cell (RBC) transfusions should usually be given only to restore or maintain oxygen delivery to vital organs and tissues. Medical history has clearly documented the importance of blood transfusion in saving lives threatened by acute haemorrhage or severe anaemia. The availability of blood products has facilitated many surgical and medical advances, allowing the support of patients who could not have previously survived invasive therapies. Consequently, the use of blood products has increased steadily over the past half century. However, recent years have seen much greater emphasis on the consequences and costs of transfusion, leading to widespread attempts to restrict blood product use. Balancing the risks and benefits of transfusion has becoming increasingly complex; while restricting transfusion reduces unwanted effects and cost, the thresholds at which the risks of poor oxygen carriage outweigh these are not always clear. Children have different physiology and pathology than adults and many aspects of transfusion practice are poorly researched in the young. This article discusses the most recent evidence available from adult and paediatric research to guide clinical RBC transfusion practice in acute paediatrics. It also discusses the current provision of RBC components for children.

[Archivists] Genes and language impairment

2009-05-21

[Problem solving in clinical practice] Where have all the neutrophils gone?

Patel, S, de la Fuente, J, Atra, A, Senevirathne, S, Cale, C M — 2009-05-21

[Pharmacy update] The use of surfactants in 2009

Sweet, D G, Halliday, H L — 2009-05-21

Surfactant replacement therapy has been available for about 25 years, revolutionising neonatal respiratory care after its introduction in the 1980s. Along with antenatal steroids, surfactants improve survival for preterm babies and they are now recommended routinely as early in the course of respiratory distress syndrome (RDS) as possible. Prophylactic treatment, although appearing ideal, exposes some babies who might manage perfectly well on continuous positive airway pressure (CPAP) to intubation and ventilation, which may increase the risk of bronchopulmonary dysplasia. Recent studies attempt to determine the optimal balance between avoiding ventilation by using CPAP and giving surfactant in a timely fashion to babies with RDS. Surfactants are also used for conditions other than RDS, such as meconium aspiration, pulmonary haemorrhage and pneumonia, although the evidence base for their use in these indications is much weaker. Recently, surfactants have been used to deliver steroids directly to the lungs and this seems to be a promising technique worthy of further study. Finally, the quest goes on to develop a synthetic product that can match the effects of animal derived natural surfactants and could be produced at lower cost.

[Guideline review] Hypercholesterolaemia in children guidelines review

Baumer, J H, Shield, J P H — 2009-05-21

[Learning and teaching] Career guidance: how do we inspire students and young doctors to careers in paediatrics and child health?

Goodyear, H M — 2009-05-21

[Archivists] Treatment of anxiety

2009-05-21

[Journal Watch] Journal Watch: Selections from Journal Watch Pediatrics and Adolescent Medicine

2009-05-21

[Evidence-Based Mental Health] Iron supplementation in non-anaemic women did not improve pregnancy outcomes and may be harmful to both mother and baby

Giorlandino, C., Cignini, P. — 2009-05-21

[Evidence-Based Mental Health] Review: symptoms, signs, and lab tests have moderate accuracy for detecting appendicitis in children

Wyer, P. C — 2009-05-21

[Evidence-Based Mental Health] Honey, not dextromethorphan, was better than no treatment for nocturnal cough in children with upper respiratory infections.

Axelsson, I. — 2009-05-21