And here are the answers…
In Nijman et al.’s 2020 single centre prospective evaluation of sepsis screening tools how many febrile children, aged 1 month−16 years, with greater than one warning sign of sepsis across 1,551 disease episodes had an invasive bacterial infection?
Answer: b) 6 (0.4%) children
Only six children (0.4%) had a final diagnosis of an invasive bacterial infection. The authors looked at the utility of sepsis screening tools to predict the presence of an invasive bacterial infection, serious bacterial infection or PICU admission; there were a huge number of false positives. The number of children needed to treat to detect one invasive bacterial infection was 256.
This study shows us that serious infections are rare and most children who are categorised as ‘at risk of sepsis’ can be managed conservatively with observation. Current guidelines have very poor specificity; and while they tell us to investigate and treat lots of children, a lot of the time we choose to rely on our clinical judgement. Observation and good clear red flagging must not be underestimated.
In Waterfield et al.’s 2020 multi-centre Petechiae in Children (PIC) study, of the 1334 included children (fever and petechial rash) how many had confirmed meningococcal disease?
Answer: a) 19 (1.4%)
Nineteen children had confirmed N. meningitidis and 8 of these needed intensive care treatment.
The primary outcome of this study was to assess the performance of 8 clinical guidelines on identifying children with invasive meningococcal disease. All 8 guidelines had a sensitivity of 100%, identifying all children with meningococcal disease, but specificity varied from 0% (NICE sepsis guideline) to 36% (Barts Health NHS Trust).
In a retrospective evaluation by Reeves et al. how many children presented with a suspected magnet ingestion in the United States between 2009 and 2019?
Answer: c) 23756
An estimated 23,756 children (59% males, 42% < 5 years old) presented with a suspected magnet ingestion in a 10 year study period between 2009 to 2019. The U.S. Consumer Safety Commission removed these products from the market in 2012 until a federal court decision reversed this decision in 2016. After 2017, there was a 5-fold increase in the escalation of care for multiple magnet ingestions.
At Christmas, parents and grandparents with full stomachs may not be quite as on the ball at minding children with new toys with magnetic parts. Be aware of the dangers of ingested magnets and be sure to investigate if there’s any suspicion.
In a single centre study Watkins et al. undertook Bayley Scales of Infant-Toddler Development (BSID-III) and neurologic examination at 18-22 months of corrected age for survivors of birth before 26 weeks. In the surviving infants, no or mild neurodevelopmental impairment in surviving infants was 3 of 4 infants at 24-25 weeks. What was the proportion in the 22-23 week group?
Answer: d) 2 of 3
This is a retrospective study assessing the survival and neurodevelopmental outcomes of infants born at 22-23 weeks compared with those born at 24-25 weeks of gestation in a single site. The cohort was stratified into 22-23 weeks gestation (n=70) and those born at 24-25 weeks gestation (n = 178). Both groups received antenatal steroids, intubation, surfactant replacement therapy, and high-frequency ventilation as the primary mode of ventilation. Survival to hospital discharge was 78% at 22-23 weeks and 89% at 24-25 weeks or gestational age (P=0.02). At 18 months, surviving infants with no or mild neurodevelopmental impairment at 22-23 weeks was 64% (29/45; 95% CI, 50%-77%) and at 24-25 weeks was 76% (94/124; 95% CI, 68%-83%; P = .16) at 24-25 weeks.
Trivić et al. undertook a systematic review and meta-analysis evaluating strain-specific probiotic interventions for paediatric functional abdominal pain (FAP) including 9randomised controlled trials published up to April 2020. How many studies reported the authors’ primary outcome which was the number of children with the cessation of pain symptoms after intervention?
Answer: a) 0
Trivić et al. suggest that the probiotic Lactobacillus reuteri can effectively reduce pain intensity and increase the number of pain-free days in children with FAP. But, there was no significant reduction in pain frequency or school absenteeism and no study actually reported the cessation of pain. Probiotics are considered safe in children, but the literature is very heterogenous with different doses and formulations and a diverse range of outcomes, making it difficult to interpret and therefore draw accurate conclusions.
Park et al sought to find evidence to support the claim that Santa Claus “knows if you’ve been bad or good, so be good for goodness sake” in their retrospective observational study of 186 members of staff who worked on paediatric wards in the UK over Christmas. But which of the following did they find?
Answer: e) Distance to the North Pole in km did not have a statistically significant effect on whether Santa Claus would or would not visit a paediatric ward
Park et al found that Santa visited all 8 of the children’s ward in Northern Ireland, with Scotland in second place with 93% coverage. Santa Claus doesn’t discriminate between children who live in areas with surrogate markers for “naughtiness.” There was no correlation between a visit from Santa and primary school absenteeism or young person conviction rates or distance to the North Pole. After Santa, the most popular local superhero visitors to the children’s wards were his elves, followed by footballers. Elsa came way down the list at joint fifth with firefighters.
This is an amusing study but it revealed a sobering fact: Santa Claus is less likely to visit children in hospitals in deprived areas. As paediatric clinicians, our role is to care for children and it may be that that care involves helping Santa access those “hard to reach” areas so that every child is happy at Christmas.
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