Nasogastric tubes

Cite this article as:
Andrew Tagg. Nasogastric tubes, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16175

There are certain procedures that we all love to do. Some people like intubations, some like lumbar punctures. Pretty much nobody likes inserting nasogastric tubes. I’ve spent many frustrated minutes, having performed the smoothest first pass intubation, wrestling with the wiggly piece of plastic known as the nasogastric tube. In this blog post I’m going to refresh our knowledge of how best to put them in, and offer some advice from Simon Walsh on another way…

Tim Horeczko: Towards A Calmer Resus at DFTB17

Cite this article as:
Team DFTB. Tim Horeczko: Towards A Calmer Resus at DFTB17, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16235

This talk was recorded live during the final plenary session of DFTB17 in Brisbane. If you missed out in 2017 then you can check out our YouTube channel to watch any of the talks.

Preventing Poisonings in the Home

Cite this article as:
Joe Rotella. Preventing Poisonings in the Home, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16269

You’ve just seen a young lady who managed to swallow a tablet out of Grandma’s handbag, whilst she was over for a visit. Luckily, it was a 20 mg esomeprazole tablet so she’s going to be ok. You go in and reassure her worried family that nothing further will occur. Feeling your job is done, you turn to leave but then her mother asks you ‘How can we prevent this happening in future?’.

What would you say?

Chronic and Persistent Pain at DFTB17

Cite this article as:
Team DFTB. Chronic and Persistent Pain at DFTB17, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16232

This talk was recorded live on the final day of DFTB17 in Brisbane. If you missed out in 2017 then why not book your leave for 2018 now. Tickets are still sale for some of the pre-conference workshops as well as the conference itself via www.dftb18.com.

Bubble Wrap Plus – June

Cite this article as:
Anke Raaijmakers. Bubble Wrap Plus – June, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16343

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly paediatric journal club reading list  from Anke Raaijmakers working with Professor Jaan Toelen & his team of the University Hospitals in Leuven. This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or simply help you to keep an finger on the pulse of paediatric research.

This June Bubble Wrap Plus provides answers to intriguing questions such as: ‘Is arthritis a common symptom in Kawasaki?’, ‘How often do we scan children with headache in the A&E department?’ and ‘What is the best infusion rate in diabetic keto-acidosis?’

You will find the list is broken down into four sections:

1.Reviews and opinion articles

Child trafficking in Europe: what is the paediatrician’s role? : A statement by the European Academy of Paediatrics.

Hadjipanayis A, et al. Eur J Pediatr. 2018 Jun 26.

The Prenatal Visit.

Yogman M, et al. Pediatrics. 2018 Jun 25. pii: e20181218.

The So-Called “Protective Effect” of Preeclampsia on Perinatal Brain Damage.

Korzeniewski SJ. Neonatology. 2018 Jun 25;114(3):212-214.

The Elephant in the Examination Room: Addressing Parent and Child Mobile Device Use as a Teachable Moment.

Erkoboni D, et al. J Pediatr. 2018 Jul;198:5-6.

Why are preterm newborns at increased risk of infection?

Collins A, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F391-F394.

The Biology of Stature.

Jee YH, et al. J Pediatr. 2016 Jun;173:32-8.

Exhaled breath testing – A tool for the clinician and researcher.

Davis MD, et al. Paediatr Respir Rev. 2018 May 17.

Protecting Infants From Sleep-Related Deaths: A Wake-up Call.

Quinlan KP, et al. JAMA Pediatr. 2018 Jun 18.

Myths, facts and controversies in the diagnosis and management of anaphylaxis.

Anagnostou K, et al. Arch Dis Child. 2018 Jun 16.

Head Ultrasound in Neonatal Hypoxic-Ischemic Injury and Its Mimickers for Clinicians: A Review of the Patterns of Injury and the Evolution of Findings Over Time.

Salas J, et al. Neonatology. 2018 Jun 22;114(3):185-197.

The unfortunate tale of immature respiratory control superimposed on an immature lung.

Martin RJ. Pediatr Res. 2018 Jun 18.

2. Original clinical studies

Breastfeeding outcomes in European NICUs: impact of parental visiting policies.

Cuttini M, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jun 28.

Maternal Intrapartum Antibiotic Administration and Infantile Colic: Is there a Connection?

Leppälehto E, et al. Neonatology. 2018 Jun 25;114(3):226-229.

Uropathogen Resistance and Antibiotic Prophylaxis: A Meta-analysis.

Selekman RE, et al. Pediatrics. 2018 Jun 28.

Dynamics of allergy development during the first 5 years of life.

Vrbova M, et al. Eur J Pediatr. 2018 Jun 22.

Arthritis in Kawasaki disease: A poorly recognised manifestation.

Martins A, et al. J Paediatr Child Health. 2018 Jun 26.

Re-examining the arterial cord blood gas pH screening criteria in neonatal encephalopathy.

Vesoulis ZA, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F377-F382.

Polyethylene glycol maintenance treatment for childhood functional constipation: A Randomized, Placebo-Controlled Trial.

Modin L, et al. J Pediatr Gastroenterol Nutr. 2018 Jun 26.

Aetiological spectrum, clinical differentiation and efficacy of polyethylene glycol over lactulose in children with constipation: Experience of 316 cases.

Poddar U, et al. J Paediatr Child Health. 2018 Jun 26.

Physical Activity and Skipping Breakfast Have Independent Effects on Body Fatness Among Adolescents.

Cayres SU, et al. J Pediatr Gastroenterol Nutr. 2018 Jun 26.

Ambulatory blood pressure monitoring and neurocognitive function in children with primary hypertension.

Kupferman JC, et al. Pediatr Nephrol. 2018 Jun 12.

Association of Gestational Age at Birth With Symptoms of Attention-Deficit/Hyperactivity Disorder in Children.

Ask H, et al. JAMA Pediatr. 2018 Jun 25.

Preterm Neuroimaging and School-Age Cognitive Outcomes.

Hintz SR, et al. Pediatrics. 2018 Jun 26.

Gastrointestinal sequelae after surgery for necrotising enterocolitis: a systematic review and meta-analysis.

Hau EM, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jun 26.

Neonatal Phototherapy: A Novel Therapy to Prevent Allergic Skin Disease for At Least 5 Years.

Ku MS. Neonatology. 2018 Jun 25;114(3):235-241.

Epinephrine versus dopamine in neonatal septic shock: a double-blind randomized controlled trial.

Baske K, et al. Eur J Pediatr. 2018 Jun 23.

Effect of rescue medication on seizure duration in non-institutionalized children with epilepsy.

Vigevano F, et al. Eur J Paediatr Neurol. 2018 Jan;22(1):56-63.

Variation in hospital mortality in an Australian neonatal intensive care unit network.

Abdel-Latif ME, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F331-F336.

Parental experience of interaction with healthcare professionals during their infant’s stay in the neonatal intensive care unit.

Gallagher K, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F343-F348.

Randomised trial of estimating oral endotracheal tube insertion depth in newborns using weight or vocal cord guide.

Gill I, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F312-F316.

Severe acquired subglottic stenosis in neonatal intensive care graduates: a case-control study.

Thomas RE, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F349-F354.

Academic performance of children born preterm: a meta-analysis and meta-regression.

Twilhaar ES, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F322-F330.

Accuracy of 11 formulae to guide umbilical arterial catheter tip placement in newborn infants.

Lean WL, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F364-F369.

Postdischarge Interventions to Prevent Pediatric Readmissions: Lost in Translation?

Gay JC. Pediatrics. 2018 Jun 22.

Postdischarge Nurse Home Visits and Reuse: The Hospital to Home Outcomes (H2O) Trial.

Auger KA, et al. Pediatrics. 2018 Jun 22.

Maternal weight and infections in early childhood: a cohort study.

Videholm S, et al. Arch Dis Child. 2018 Jun 21.

Prenatal Antidepressant Exposure and Child Motor Development: A Meta-analysis.

Grove K, et al. Pediatrics. 2018 Jun 21.

Hunger: A Missed Opportunity for Screening in the Pediatric Emergency Department.

Robinson T, et al. Clin Pediatr (Phila). 2018 Jun 1:9922818778044.

Emergency Department Use of Neuroimaging in Children and Adolescents Presenting with Headache.

Cain MR, et al. J Pediatr. 2018 Jun 14.

Cord milking versus immediate clamping in preterm infants: a randomised controlled trial.

El-Naggar W, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jun 14.

A Multifaceted Intervention To Reduce Pediatric Acid-Suppressant Prescriptions for GER: What Have We Learned?

Steutel NF, et al. J Pediatr Gastroenterol Nutr. 2018 Jun 12.

Association of newborn screening metabolites with risk of wheezing in childhood.

Donovan BM, , et al. Pediatr Res. 2018 Jun 1.

Outcomes in Mild to Moderate Isolated Thrombocytopenia.

Schlappi C, et al. Pediatrics. 2018 Jun 11.

Characteristics of Children With Invasive Pneumococcal Disease After the Introduction of the 13-valent Pneumococcal Conjugate Vaccine in England and Wales, 2010-2016.

Makwana A, et al. Pediatr Infect Dis J. 2018 Jul;37(7):697-703.

Neurological assessment of late-preterm infants during the first year of age.

Romeo DM, et al. Eur J Paediatr Neurol. 2018 Jul;22(4):579-580.

Behavioral Outcomes of Infant Colic in Toddlerhood: A Longitudinal Study.

Bell G, et al. J Pediatr. 2018 Jun 7.

Early childhood curiosity and kindergarten reading and math academic achievement.

Shah PE, et al. Pediatr Res. 2018 Apr 26.

The effectiveness of an online training programme to prepare teachers to provide asthma first aid.

Luckie K, et al. J Paediatr Child Health. 2018 Jun 8.

Paracetamol/Acetaminophen During Pregnancy Induces Prenatal Ductus Arteriosus Closure.

Becquet O, et al. Pediatrics. 2018 Jun 7. pii: e20174021.

Neonatal Circumcision and Urinary Tract Infections in Infants With Hydronephrosis.

Ellison JS, et al. Pediatrics. 2018 Jun 7.

Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study.

Shalaby MA, et al. Pediatr Nephrol. 2018 Jun 5.

Etiologies and Yield of Diagnostic Testing in Children Presenting to the Emergency Department with Altered Mental Status.

Button K, et al. J Pediatr. 2018 Jun 1.

Comparison of a smartphone-based ECG recording system with a standard cardiac event monitor in the investigation of palpitations in children.

Macinnes M, et al. Arch Dis Child. 2018 Jun 2.

Drug utilisation among Dutch adolescents: a pharmacy prescription records study.

Kosse RC, et al. Arch Dis Child. 2018 Jun 1.

Course of acute nonspecific mesenteric lymphadenitis: single-center experience.

Benetti C, et al. Eur J Pediatr. 2018 Feb;177(2):243-246.

Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis.

(See DFTB feature post on this article!)

Kuppermann N, et al. N Engl J Med. 2018 Jun 14;378(24):2275-2287.

Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration.

Askie LM, et al. JAMA. 2018 Jun 5;319(21):2190-2201.

Optimizing Oxygen Saturation Targets in Extremely Preterm Infants.

Bizzarro MJ. JAMA. 2018 Jun 5;319(21):2173-2174.

 

3. Guidelines and best evidence

Vitamin D intake for preterm infants: how much do they really need?

Onwuneme C, et al. Arch Dis Child. 2018 Jun 27.

Clinical practice: recognizing child sexual abuse-what makes it so difficult?

Vrolijk-Bosschaart TF, et al. Eur J Pediatr. 2018 Jun 25.

Radiographic appearance and clinical significance of fidget spinner ingestions.

Sammer MBK, et al. Pediatr Radiol. 2018 Jun 28.

Improving Guideline-Based Streptococcal Pharyngitis Testing: A Quality Improvement Initiative.

Norton LE, et al. Pediatrics. 2018 Jun 20.

Prediction of bronchopulmonary dysplasia development.

Hunt KA, et al. Arch Dis Child Fetal Neonatal Ed. 2018 Jun 12.

Arterial line cannulation in children: Is it time for guidelines?

Tosetti S, et al. Paediatr Anaesth. 2018 Jun;28(6):564-565.

Clinical Practice: Nausea and vomiting in acute gastroenteritis: physiopathology and management.

Canziani BC, et al. Eur J Pediatr. 2018 Jan;177(1):1-5.

4. Case reports

A Toddler With Treatment-Resistant Iron Deficiency Anemia.

Conway M, et al. Pediatrics. 2018 Jun 27. pii: e20172971.

Unilateral Neck Mass in a Neonate.

Baik G, et al. J Pediatr. 2018 Jun 8.

Unusual cutaneous lesions, two different presentations.

Cascais MM, et al. J Paediatr Child Health. 2018 Jun;54(6):700.

Childhood Visual Hallucinations: A Case Report of Idiopathic Occipital Epilepsy.

Alba Palé L, et al. J Am Acad Child Adolesc Psychiatry. 2018 Jun;57(6):436-438.

Otorrhoea with facial palsy in a child.

Chen YJ, et al. Arch Dis Child. 2018 Jun 1.

A Mediastinal Mass in a Young Man.

Jain S, et al. JAMA. 2018 Jun 19;319(23):2432-2433.

Wandering Liver, Wondering Doctors!

Matarazzo L, et al. J Pediatr. 2018 Jun 25.

 

If we have missed out on something useful or you think other articles are absolutely worth sharing, please add them in the comments!

The Toxicological Risk Assessment

Cite this article as:
Joe Rotella. The Toxicological Risk Assessment, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16255

Hello and welcome to Twinkle Twinkle Little Tox, a new section for Don’t Forget the Bubbles on Paediatric Toxicology!

I’m humbled and honoured to have the opportunity to contribute to this amazing site and join a team of dedicated medical educators. A special thanks to Andy Tagg for the chance and to Shaun Greene and Jeff Robinson from the Victorian Poisons Information Centre for their support in producing these blog posts.

Cannabinoids in Epilepsy at DFTB17

Cite this article as:
Team DFTB. Cannabinoids in Epilepsy at DFTB17, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16227

John Lawson is a paediatric neurologist at Sydney Children’s Hospital in Randwick. He has been Lead Investigator in the NSW Medical Cannabis in Epilepsy trial and is one of Australia’s leading experts on its use in near intractable seizures.

This is an almost evidence-free zone as the popular press has taken up the fight on behalf of patients.

So what are doctors to do, when parents come to them asking them to prescribe cannabis to their one year old child? This is not a talk about the wholesale legalisation of marijuana but about how, once again, we need to take a closer look at the evidence.


This double-blinded, placebo controlled trial reported in last years NEJM sets the scene for the the potential beneficial effects of cannabidiols.

Go ahead and watch the talk…

You can read this latest paper, a narrative review of some of the challenges facing the use of medical cannabis in the Medical Journal of Australia.

Chen KA, Farrar MA, Cardamone M, Lawson JA. Cannabis for paediatric epilepsy: challenges and conundrums. The Medical Journal of Australia. 2018 Feb 19;208(3):132-6.

DOI and Altmetric

Cite this article as:
Tessa Davis. DOI and Altmetric, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16287

This month, DFTB launched our one year trial of a new way of measuring impact and encouraging the referencing and sharing of our posts. We have done three things: added a Cite box; got DOIs for each post; added the use of Altmetric.

Debate has been ongoing for several years about how best to measure impact and quality for FOAM resources. There have been a few proposals to date.

 

Evaluation of quality in FOAM

The AIR modules are a project by the team at ALiEM to put together high quality FOAM articles to make up a learning module on a particular topic. They have an Executive Board which reviews FOAM posts and scores them using an objective scoring system. The highest scoring posts are included in the teaching module. Their scoring tool looks at: BEEM score; content accuracy; educational utility; evidence based medicine and references.

This series has been an excellent contribution to the conversation around FOAM evaluation. However, articles have to be selected to appear in an AIR module, so for those us who would like to be able to demonstrate the quality of each of own posts, we need to consider another solution.

 

Evaluation of impact in FOAM

To measure impact, Brent Thoma started the social media index a few years ago which ranks all FOAM sites for their social impact (DFTB is currently 15th overall which as a paediatric specific blog we are very happy with indeed, although always strive to improve).

 

There is a difference between quality and impact – this is an issue faced by mainstream journal publications too. To ensure quality, they have pre-publication peer review – we do a version of this for DFTB. To measure impact, they have Impact Factor and many use Altmetric. They measure impact by how their articles are cited or shared by others. This does not take into account knowledge translation.

In the Weingart paper there is discussion around the idea that Impact Factor only centres on being cited by another article. The authors suggest that to assess the impact of FOAM ‘a new Estimate of Clinical Influence could take into account number of online page views an article receives, downloads, discussion forum comments, as well as mentions, links and viral sharing on Twitter, Facebook, and other social media.

In essence this is what we do already with FOAM when we document how many times our article is shared. At DFTB we have had sharing counts at the top of each post for many years and we feel this transparency is important for readers too. But sharing counts alone doesn’t resonate with mainstream publications, and we wanted to look for something that could compare us directly.

 

Why do we care about mainstream journals?

Peer-reviewed publications producing original research will always be the main tenet of clinical and scientific advancement. FOAM content cannot replace this, but it can be part of the conversation. There has been discussion previously about the role FOAM has to play in knowledge translation, and adding the voice of practical experience to allow the interpretation of scientific research and its integration into our clinical practice.

We have something to add to traditional journals, as our reach and ability to connect with the medical community is something that can be a challenge for journals. Examples for DFTB are where we have worked with research groups to share our interpretation of their publications (i.e. the PREVIEW trial or the PARIS trial).

Altmetric is used by many journals (including JAMA, EMJ, BMJ, and ADC) for the purpose assessing broader social impact, and we believe this is the integration of social media into mainstream journals that was predicted in the Weingart and Faust paper. In order to try to find common ground with mainstream journals regarding impact assessment, we decided to implement a one year trial of Altmetric in DFTB.

 

Trial of Altmetric and journal comparison

We believe we are the first FOAM site to implement Altmetric and a barrier to this is most likely the cost. Most FOAM sites (including DFTB) get no external funding, and therefore cannot afford the Altmetric fee. The DFTB team has been running an acute paediatric conference for the last two years (see DFTB18.com), and have been able to use funds from this to support us continuing to produce FOAM content on the main DFTB website. This year we have used the funds to purchase an Altmetric annual subscription.

Altmetric only works prospectively on posts, so although it is shown in older posts, it will only count shares from when we started our Altmetric subscription. We noted at the beginning that it was only counting tweets and missing Facebook, LinkedIn, and other blogs shares, so there have been some teething issues and it has taken a while to get up and running.

At the end of the year we will aim to look back at the most recent posts and compare the Altmetrics to recent publications from mainstream journals. We can also compare our most popular posts to their most popular articles. Our aim is to be able to use this to demonstrate the impact of our FOAM content, and also to be able to speak in a language understood by mainstream publications.

 

Why do we have DOIs and a Cite box?

We now have DOIs for all DFTB posts. A DOI is a unique identifier that links to the post – you will have seen them on all journal articles. This facilitates easier citing of our posts, and also allows the tracking required for Altmetric scores.

Additionally, we’ve added a cite box, inspired by First10EM who implemented this some time back (EDIT: note that this was first implemented by Scott Weingart at EMCrit). This is simply a box at the top of each post stating how to reference our posts. This is the secondary aim of our project – to encourage people to cite our posts when writing articles for mainstream publications by putting them in an easy format that correlates with the requirements of journal citations.

 

References

Alper Cevik A, Aksel G, Akoglu H, Emre Eroglu S, Ozgur Dogan N, Ali Altunci Y. Social media, FOAMed in medical education and knowledge sharing: Local experiences with international perspective. Turkish Journal of Emergency Medicine. 2016;16(3);112-117. https://doi.org/10.1016/j.tjem.2016.07.001.

Grock A, Paolo W. Free open access medical education: a critical appraisal of techniques for quality assessment and content discovery. Clinical and Experimental Emergency Medicine. 2016;3(3):183-185. doi:10.15441/ceem.16.156.

Weingart S, Faust J. Future evolution of traditional journals and social media medical education. Em Med Aus. 2914;26:62-66. doi: 10.1111/1742-6723.12192.

Autism spectrum disorder (Part 4) – We have a diagnosis…what’s next?

Cite this article as:
Mary Hardimon. Autism spectrum disorder (Part 4) – We have a diagnosis…what’s next?, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.15458

After meeting with Charlie and his family multiple times and getting further history from his daycare, you determine that Charlie does indeed have autism. You remember that early intervention programs have been shown to improve overall outcome but aren’t sure where to start 

Ross Fisher: What surgeons wish you knew from DFTB17

Cite this article as:
Team DFTB. Ross Fisher: What surgeons wish you knew from DFTB17, Don't Forget the Bubbles, 2018. Available at:
https://doi.org/10.31440/DFTB.16201

This talk was recorded live on the final of DFTB17 in Brisbane. If you missed out in 2017 then why not book your leave for 2018 now. Tickets are on sale for the pre-conference workshops as well as the conference itself at www.dftb18.com.

What more can be said about Ross Fisher that hasn’t already been said? Passionate presenter, good (but not perfect*) surgeon and friend to the stars – in this talk Ross delves into the hidden world of paediatric surgery.