What’s your preferred BRUE?: Sarah McNab at DFTB19

Cite this article as:
Team DFTB. What’s your preferred BRUE?: Sarah McNab at DFTB19, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.22639

Sarah McNab, Director of General Paediatrics at the Royal Children’s Hospital in Melbourne, takes us through an interactive case of a child with an apparent, life-threatening event. At least that is what we used to call it. Is it a BRUE or is it something more serious? Should parents buy a home apnoea monitor? The guidelines say ‘No’ but Sarah offers an alternative view.

This talk was recorded live at DFTB19 in London, England. With the theme of  “The Journey” we wanted to consider the journeys our patients and their families go on, both metaphorical and literal. DFTB20 will be held in Brisbane, Australia.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

Haemolytic Uraemic Syndrome

Cite this article as:
Jennifer Watt. Haemolytic Uraemic Syndrome, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.26233

What is HUS?

Haemolytic Uraemic Syndrome is a combination of findings which involves the triad of:

  • Microangiopathic haemolytic anaemia with red blood cell fragmentation on blood film
  • Acute renal failure
  • Thrombocytopenia

 What causes HUS?

About 90% of cases follow an infection, most commonly with entero-haemorrhagic E. Coli (EHEC). Other infective causes to be considered include Shigella and Streptococcus pneumoniae.

These infections are commonly contracted by the ingestion of contaminated food or water sources. In the US and UK, E. Coli 0.157 forms part of the natural intestinal microflora of cattle and sheep, therefore infection can be caused by direct contact with animal faeces. This can take place at farms or petting zoos, or via undercooked contaminated meat or dairy products.

The other 10-15% of cases represent atypical HUS and are due to a variety of causes, which will not be discussed here.

How do children present?

In children infected with EHEC about 10-15% of them will go on to develop HUS.

The common presentation includes bloody diarrhoea +/- cramping abdominal pain, fever and/or vomiting. The average onset of HUS after development of diarrhoea is about 7-10 days, with children under the age of 5 at highest risk.

Dependent on the extent of HUS progression, children may present with pallor, oedema, lethargy, or reduced urine output.

How to approach the examination

As with any unwell child, an A to E assessment is critical to rule out any immediate, life threatening complications.

Specific attention should be paid to assessing their fluid status, especially for evidence of dehydration.

*Although they may be oedematous, it is important to assess if they are intra-vascularly dry.

Things to examine for:

  • Prolonged capillary refill time
  • Observations: Tachycardia; hypotension or hypertension
  • Are they are cool peripherally?
  • Assess fontanelle tension (if applicable)
  • Dry mucus membranes/reduced skin turgor
  • Oedema (common locations in children include lower limbs, sacral and peri-orbital)

Is there evidence of neurological sequelae?

  • Irritable/restlessness
  • Confusion
  • Reduced GCS

Key investigations to perform

A. Initial blood samples:

  • Full blood count with blood film to assess for RBC fragmentation
  • Coagulation
  • Group and Save +/- cross match if haemoglobin low
  • Biochemistry: U&Es, calcium, phosphate, magnesium, bicarbonate
  • Glucose
  • CRP
  • Liver function including albumin
  • Amylase/Lipase (hospital dependent)
  • LDH
  • Blood gas
  • Blood cultures

B. Stool MC&S + E. Coli PCR

C. Urinalysis + MC&S

How to approach the management of HUS

Management should always be discussed with your local paediatric nephrologist in order to individualise/optimise management.

This is a generalised framework for the approach to management. Treatment involves supportive therapy to allow time for the infection to clear and the HUS process to cease.

1. Fluid Management:

  • IV access
  • Assess fluid status
  • Monitor for electrolyte disturbances and correct as per local guidelines
  • Daily weight, In/Out fluid balance, close monitoring of patient observations

*Fluid rehydration should be administered cautiously and in the setting of oliguria/anuria and oedema, fluids given should not exceed insensible loss + urine output.

*Evidence has shown that children presenting to hospital with dehydration in the prodromal phase of EHEC-induced HUS have a higher risk of developing an oliguric AKI and the requirement for dialysis. The administration of isotonic fluid in this phase has shown to be nephroprotective. 

2. Hypertension:

  • Can be secondary to fluid overload or as a result of the HUS process
  • Trial of diuretics or if receiving dialysis, fluid can be offloaded
  • If unresponsive to diuretics, consider a vasodilator (For example, amlodipine/ nifedipine *hospital dependent)

3. Anaemia:

  • Target Haemoglobin: 70-100g/L
  • Avoid excessive transfusion due to the associated risk of development of hyperkalaemia or fluid overload

4. Thrombocytopenia:

  • Consideration for platelet transfusion if platelets <10 x109
  • If undergoing surgery may require platelets > 50 x 109

5. Abdominal pain/vomiting:

  • Secondary to colitis
  • Regular paracetamol for pain relief
  • Avoid opiates if possible due to constipating side effects

*NSAIDS like Ibuprofen should not be prescribed*

6. Nutrition:

  • All patients should be reviewed by a dietician
  • NG tube and feeding regime

7. Dialysis (Peritoneal Dialysis or Haemodialysis) Indications:

  • Intractable acidosis
  • Diuretic resistant fluid overload
  • Electrolyte abnormalities Hyperkalaemia
  • Symptoms of uraemia

In children with HUS, peritoneal dialysis is the preferred treatment option as it is a gentler form of dialysis.

Haemodialysis is indicated for children with severe colitis, severe electrolyte abnormalities and those with neurological complications.

 HUS Complications

  • AKI:  Oliguria/anuria; hyperkalaemia; hypertension
  • Neurological: Irritable, confusion, seizures
  • Bleeding Risk
  • Cardiac: Hypertensive cardiomyopathy/myocarditis
  • Gastrointestinal: Severe colitis with bleeding/perforation
  • Pancreatitis
  • Pulmonary oedema

Selected references

Mayer CL, Leibowitz CS, Kurosawa S and Stearns-Kurosawa DJ. Shiga Toxins and the Pathophysiology of Hemolytic Uremic Syndrome in Humans and Animals. Toxins (Basel). Nov 2012. [Cited June 2020]; 4 (11): 1261-1287. doi: 10.3390/toxins4111261

Kausman. J 517 Haemolytic uraemia syndrome. Royal Hospital for Children- Nephrology. Dec 2013. [Cited June 2020]; Available from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509707/

Hughes D. Management and investigation of bloody diarrhoea and haemolytic uraemic syndrome [draft].  GG&C Paediatric Guidelines- Kidney Diseases. Oct 30 2019. [Cited June 2020]; Available from: https://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-guidelines/kidney-diseases/management-and-investigation-of-bloody-diarrhoea-and-haemolytic-uraemic-syndrome-draft/

Balestracci A et al. Dehydration at admission increased the need for dialysis in hemolytic uremic syndrome children. Pediatr Nephrol. 2012. [ Cited June 2020];27: 1407-1410. Doi: 10.1007/s00467-012-2158-0

Scheiring J. Andreoli SP. Zimmerhackl LB. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Ped Neprhrol. 2008. [Cited June 2020]; 23: 1749-1760. Doi: 10.1007/s00467-008-0935-6

Grisaru Silviu. Management of hemolytic-uremic syndrome in children. Int J Nephrol Renovasc Dis. 2014 [Cited June 2020]; 7: 231-239. Doi: 10.2147/IJNRD.S41837.

Metabolic presentations part 1: neonates

Cite this article as:
Taciane Alegra. Metabolic presentations part 1: neonates, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.28423

You are working in the Paediatric Emergency Department and are called in to see a neonate with a history of irritability and seizures. You enter the room and are told the following: “Emma is a 3 day old, term baby who has been refusing feeds and crying excessively. Her mother says she has been irritable since birth. There has been no history of fever or cough. At home she had seizure-like activity with tonic posturing”. When you examine her, you find an awake, extremely irritable baby with flexed upper limbs flexed, extended lower limbs and global hyperreflexia. She is not dysmorphic and has no cardiac murmurs, respiratory distress or abdominal organomegaly.

Babies cry (a lot!) and we all know that, however Emma is presenting some red flags: she’s irritable and has an acute onset of seizures, without any obvious trigger.

The basics

In this post we will discuss some acute metabolic presentations in the neonatal period, how to identify potential problems and emergency treatment in the ED. You don’t need to make a diagnosis (bonus points if you do) but do need to remember that spotting the zebra will lead to more favourable outcomes. Metabolic diseases / disorders are also called inborn errors of metabolism (IEM).

How common are metabolic conditions?

Individually, metabolic conditions are rare, most having an incidence of less than 1 per 100,000 births. However, when considered collectively, the incidence may reach 1 in 800 to 1 in 2500 births (Applegarth et. al, 2000; Sanderson et.al, 2006). 

Remember: some symptoms can be unspecific and can mimic sepsis; or a child with an undiagnosed metabolic condition can decompensate with an intercurrent infection. 

An easy-to-understand classification by Saudubray divides the IEM in three groups of disorders, depending on how they present. 

Intoxication disorders

An acute or progressive intoxication from the accumulation of toxic compounds, usually small molecules. 

These usually present with a symptom-free interval and clinical signs of ‘intoxication’, which may be acute, although can be intermittent.

  • disorders of amino acid catabolism: e.g. phenylketonuria, maple syrup urine disease, homocystinuria, tyrosinemia 
  • most organic acidurias: e.g. methylmalonic, propionic, isovaleric acidaemia
  • urea cycle defects: e.g. Ornithine transcarbamylase deficiency (OTC deficiency), Citrullinemia type I (ASS1 deficiency).
  • sugar intolerances: galactosemia
  • metals: Wilson’s, Menkes, hemochromatosis
  • porphyrias

Disorders involving energy metabolism

A deficiency in energy production or utilization, within the liver, myocardium, muscle, brain or other tissues. 

Common symptoms include hypoglycemia, hyperlactatemia, hepatomegaly, failure to thrive and cardiac failure. 

  • Mitochondrial defects: congenital lactic acidemias (defects of pyruvate transporter, pyruvate carboxylase, pyruvate dehydrogenase, and the Krebs cycle), mitochondrial respiratory chain disorders and the fatty acid oxidation defects (MCAD deficiency).
  • Cytoplasmic energy defects: disorders of glycogen metabolism (collectively known as glycogen storage diseases), hyperinsulinism.  

Complex molecules disorders

Problems in the synthesis or catabolism of complex molecules, leading to storage of big molecules. 

Symptoms are chronic, progressive and independent of intercurrent events or food intake. 

  • Mucopolysaccharidosis (I-IV, VI and VII). The eponymous names are used less frequently now, particularly in the literature, but you might come across them in clinical practice (MPS I, Hurler’s Syndrome; MPS II, Hunter’s Syndrome; MPS VI, Maroteaux- Lamy) 
  • Gaucher disease
  • Peroxisomal disorders: e.g. X-linked adrenoleukodystrophy (X-ALD) and Zellweger’s Syndrome.

Treatment strategies

Remember your biochemistry: a substrate is transformed by an enzyme into a product .

If there is a problem with the enzyme, the substrate will accumulate. If this substrate accumulation is a problem, we eliminate it, like avoiding protein in the diet or removing toxins with treatments such as ammonia scavengers.  If a lack of the product is the problem, we can supplement it (for example the administration of carbohydrate in glycogen storage disease). And for some diseases the  enzyme can be “corrected” with organ transplantation or enzyme replacement therapy.

A bonus on smells

Due to accumulation of “unusual” products in their body fluids, people with certain metabolic conditions have distinctive odours (better observed in urine, for practical reasons):

  • Maple syrup, burnt sugar, curry: Maple syrup urine disease
  • Sweaty feet: glutaric aciduria type II, isovaleric acidaemia
  • Cabbage: tyrosinemia
  • Mousy, musty: phenylketonuria
  • Rotting fish: trimethylaminuria
  • Swimming pool: Hawkinsinuria 

Back to Emma. You explain to Emma’s mother that there are lots of things that could be making her unwell so you’re going to send some tests to help work out what the problem is. You put in a cannula, take a gas, send some bloods to the lab and set her and her mother up to collect a urine.

Seeing that Emma has a metabolic acidosis on her gas you send a metabolic screen: plasma amino acids, urine organic acids, acylcarnitine profile. Her urine dip has some ketones but is otherwise unremarkable, except for a strange smell of sweaty feet…

Remembering a fabulous infographic about the importance of calculating the anion gap in children with a metabolic acidosis (and how to interpret them!), you get out your pen and paper and do the following calculations: 

Just as you’re pondering the causes of a raised anion gap, the lab phones with Emma’s blood results… Her ammonia is 184!

Emma has an acute neurological presentation, with metabolic acidosis, increased anion gap and mildly elevated ammonia, suggestive of an organic acidaemiaIn the context of a sick neonate with a raised anion gap, a normal lactate and normal ketones, think organic acids.

Are you familiar with ammonia?

A normal ammonia level is <50 mol/l but mildly raised values are common, up to 80 mol/l.

In neonates, any illness may be responsible for values up to 180 mol/l.

Artifactually high values can be caused by muscle activity, haemolysis or delay in separating the sample. Capillary samples are often haemolysed or contaminated and therefore should not be used.

There’s debate as to whether a level of >100 or 200 should be discussed with a metabolic specialist, but if in doubt, follow the RCPCH DeCon guideline and seek advice for any patient presenting with a level >100 mmol/l.

Urine organic acids and blood acylcarnitines will also be sent as part of this baby’s metabolic work-up. Although the results won’t be available in ED, the urine organic acid profile will confirm a diagnosis of an organic acidaemia, while the blood acylcarnitine profile will support the diagnosis as the organic acids conjugate with carnitines creating compounds such as isovalerylcarnitine.

The emergency treatment of suspected organic acidaemias

It’s important to think about your differentials. Sepsis is the most common – these conditions can mimic sepsis, or decompensation can be triggered by an infection, always cover with broad spectrum antibiotics. But don’t forget non-accidental injury and other differentials – the baby is likely to need a CT head if presenting encephalopathic or with seizures. If she continues to seize, load with an anticonvulsant.

 Specific emergency treatment of her metabolic presentation requires:

  • stopping sources of protein (milk)
  • avoiding catabolism (by giving glucose IV – 2mL/kg 10% glucose) 
  • rehydration (IV fluids resuscitation and maintenance)

What about that urine?

The “sweaty feet” smell of the urine points towards the diagnosis of Isovaleric Acidaemia. Remember that this condition can be part of the Newborn Screening in some countries (Ireland, UK, Australia, New Zealand).

Isovaleric acidaemia is a type of organic acidemia, inherited in an autosomal recessive way. It is caused by a problem with the enzyme that usually breaks down the amino acid leucine. This amino acid accumulates and is toxic at high levels, causing an ‘intoxication’ encephalopathy. The sweaty feet smell is stronger without treatment or  during acute exacerbations.

Maple Syrup Urine Disease (MSUD) is another organic acidaemia, associated with sweet smelling urine during decompensation. These children cannot break down leucine, valine and isoleucine. They may not have hypoglycaemia, hyperammonemia or acidosis and, if not picked up on newborn screening, can be diagnosed late, resulting in neurological sequelae.

Organic acidaemias: the take homes

  • Always measure the anion gap and send an ammonia sample in any sick neonate.
  • Sick neonates with metabolic acidosis, increased anion gap and mildly elevated ammonia may have an organic acidemia.
  • Treatment is to stop feeds, prevent catabolism with 10% dextrose (and standard electrolytes for IV maintenance) and cover for sepsis with IV antibiotics, whilst considering other differentials.

The next case feels like déjà vu…

The next baby you see is remarkably like Emma but with a subtle difference. Lucy is a 3 day old baby, presenting with poor feeding, irritability and seizures at home. There has been no fever, cough, coryza, or sick contacts. On examination she’s awake, extremely irritable, with upper limbs, extended lower limbs extended and global hyperreflexia. She has no dysmorphic features, cardiac murmur or abdominal organomegaly. You notice that she seems tachypnoeic at 70, although her lungs are clear. The rest of her observations are normal. 

The key differences between Emma and Lucy’s presentations is that Lucy is tachypnoeic and has a respiratory alkalosis; this should make you suspicious of hyperventilation. Always check an ammonia level in sick babies, but particularly in this case as hyperammonemia stimulates the brain stem respiratory centre, causing hyperventilation and, as consequence, respiratory alkalosis. 

The lab phones you with Lucy’s ammonia result…

Acute neurological presentations, with respiratory alkalosis and extremely elevated ammonia point towards a urea cycle disorder. Respiratory alkalosis is a common early finding caused by hyperventilation secondary to the effect of hyperammonemia on the brain stem, although later the respiratory rate slows as cerebral oedema develops and an acidosis is seen. Lucy also has a low urea and mildly deranged liver enzymes and INR, all of which support the diagnosis of a urea cycle disorder.

The emergency treatment of suspected urea cycle disorders

Overall the acute treatment is similar to the first case: cover for sepsis, manage seizures and consider differentials.

And as in the first suspected metabolic case:

  • stop sources of protein – stop feeds 
  • avoid catabolism – giving glucose IV – 2mL/kg 10% glucose 
  • rehydrate – IV fluids resuscitation and maintenance

In urea cycle disorders, the toxic metabolite is ammonia, so ammonia scavengers are used, all given intravenously:

  • sodium benzoate
  • phenylbutyrate 
  • arginine

A nice guideline on the management of hyperammonemia secondary to an undiagnosed cause can be found on the British Inherited and Metabolic Disease Group website.

Urea cycle disorders are autosomal recessive inborn errors of metabolism. A defect in one of the enzymes of the urea cycle, which is responsible for the metabolism of nitrogen waste from the breakdown of proteins, leads to an accumulation of ammonia as it cannot be metabolised to urea. The urea cycle is also the only endogenous source of the amino acids arginine, ornithine and citrulline.   The most common urea cycle disorder is Ornithine Transcarbamylase (OTC) deficiency. Unlike the other urea cycle disorders (which are autosomal recessive), OTC deficiency is x-linked recessive, meaning most cases occur in male infants. Female carriers tend to be asymptomatic.

CPSI: Carbomoyl Phosphate Synthetase; OTC: Ornithine Transcarbamylase; ASS: Arginosuccinate Acid Synthase; ASL: Arginosuccinate; ARG: Arginase

Classically, urea cycle disorders present in the neonatal period with vomiting, anorexia and lethargy that rapidly progresses to encephalopathy, coma and death if untreated. In these circumstances, ammonia accumulates leading to a very high plasma ammonia. 

Children presenting in infancy generally have less acute and more variable symptoms than in the neonatal period and include anorexia, lethargy, vomiting and failure to thrive, with poor developmental progress. Irritability and behavioural problems are also common. The liver is often enlarged but, as the symptoms are rarely specific, the illness is initially attributed to many different causes that include gastrointestinal disorders. The correct diagnosis is often only established when the patient develops a more obvious encephalopathy with changes in consciousness level and neurological signs. 

Adolescents and adults can present with encephalopathy and or chronic neurological signs. 

What are ammonia scavengers?

In urea cycle defects, ammonia cannot be converted to urea so instead is converted to glutamine and glycine. 

Ammonia scavengers phenylbutyrate and sodium benzoate offer alternative pathways for ammonia excretion through urinary pathways.

Phenylglutamine and hippurate are produced and are excreted in urine.

Urea cycle disorders: the take homes

  • Always measure the anion gap and send an ammonia sample in any sick neonate.
  • Sick neonates with respiratory alkalosis, normal anion gap and very elevated ammonia may have a urea cycle defect. 
  • Emergency treatment of urea cycle disorders is the same as for an organic acidaemia (stopping feeds, starting dextrose and rehydrating) PLUS intravenous ammonia scavengers.

Thank you to Dr Roshni Vara, Consultant in Paediatric Inherited Metabolic Disease at the Evelina London Children’s Hospital for her help with this post.

References

Adam , HH. Ardinger, RA. Pagon, S. E. Wallis, L. J. H. Bean, K. Stephens, & A. Amemiya (Eds.), GeneReviews® [online book].

Applegarth DA, Toone JR, Lowry RB. Incidence of inborn errors of metabolism in British Columbia, 1969-1996. Pediatrics. 2000 Jan;105(1):e10.

Sanderson S, Green A, Preece MA, Burton H. The incidence of inherited metabolic disorders in the West Midlands, UK.Arch Dis Child. 2006 Nov;91(11):896-9. 

Saudubray J-M, Baumgartner MR, Walter JH. (editors) Inborn Metabolic Diseases. Diagnosis and treatment. 6th Edition. Springer 2016. 

It’s Only Wheeze – Treatment Is Simple, Isn’t It?: Meredith Borland at DFTB19

Cite this article as:
Team DFTB. It’s Only Wheeze – Treatment Is Simple, Isn’t It?: Meredith Borland at DFTB19, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.20828

Meredith Borland is a paediatric emergency physician and the Director of Emergency Medicine at Perth Children’s Hospital in Perth, Western Australia. She was a founding member of the PREDICT Executive and is the current chair of PREDICT.

Last year at DFTB18, Meredith continued an ongoing discussion about the use of steroids in wheeze. This year, she took us on a journey through an emergency department visit for a number of children who may or may not receive various interventions. This was a fun, interactive and thought-provoking talk that highlighted some common differences in practice.

#doodlemed on this talk by @char_durand below

This talk was recorded live at DFTB19 in London, England. With the theme of  “The Journey” we wanted to consider the journeys our patients and their families go on, both metaphorical and literal.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

Bubble Wrap Plus July/August 2020

Bubble Wrap Plus – July/August 2020

Cite this article as:
Anke Raaijmakers. Bubble Wrap Plus – July/August 2020, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.28628

Here is our bumper Bubble Wrap Plus, our monthly paediatric Journal Club List provided by Professor Jaan Toelen & his team of the University Hospitals in Leuven (Belgium). This comprehensive list of ‘articles to read’ comes from 34 journals, including Pediatrics, The Journal of Pediatrics, Archives of Disease in Childhood, JAMA Pediatrics, Journal of Paediatrics and Child Health, NEJM, and many more.

This bubble wrap plus list features answers to intriguing questions such as: ‘Should we blame acid reflux for distress in infants?’, ‘Is there an association between enteric viruses and NEC?’, ‘Is there a value in US guided surfactant administration?’, ‘Do healthy children with a cervical lymph node need an ultrasound?’ and ‘Was there an outbreak of anorexia co-occurring with the pandemic?’.

1.Reviews and opinion articles

JULY HIGHLIGHTS

Ethical and Public Health Implications of Targeted Screening for Congenital Cytomegalovirus.

Gievers LL, et al. Pediatrics. 2020 Jun 26.

Reintroducing Dyslexia: Early Identification and Implications for Pediatric Practice.

Sanfilippo J, et al. Pediatrics. 2020 Jun 23.

Who has been missed? Dramatic decrease in numbers of children seen for child protection assessments during the pandemic.

Bhopal S, et al. Arch Dis Child. 2020 Jun 18.

The role of dietary fibre and prebiotics in the paediatric diet.

Boctor D. Paediatr Child Health. 2020 Jun;25(4):263-264.

Do facemasks protect against COVID-19?

Isaacs D, et al. J Paediatr Child Health. 2020 Jun;56(6):976-977.

To what extent do children transmit SARS-CoV-2 virus?

Isaacs D, et al. J Paediatr Child Health. 2020 Jun;56(6):978-979.

Should I be worried about carrying the virus that causes COVID-19 home on my clothes?

Howard-Jones A, et al. J Paediatr Child Health. 2020 Jun;56(6):980.

Maturation of glomerular filtration rate in neonates and infants: an overview.

Iacobelli S, et al. Pediatr Nephrol. 2020 Jun 11.

Microbiome in health and disease.

Giles EM, et al. J Paediatr Child Health. 2020 Jun 5.

Machine Learning and Artificial Intelligence in Pediatric Research: Current State, Future Prospects, and Examples in Perioperative and Critical Care.

Lonsdale H, et al. J Pediatr. 2020 Jun;221S:S3-S10.

Clinical Genomics in Critically Ill Infants and Children.

Raymond FL. JAMA. 2020 Jun 23;323(24):2480-2482.

AUGUST HIGHLIGHTS

Is Ileocolonoscopy Necessary When Evaluating Abdominal Pain and Nonbloody Diarrhea?

Sullivan JS, et al. Pediatrics. 2020 Jul 21:e20200699

Water fluoridation: current challenges.

Furness J, et al. Arch Dis Child. 2020 Jul 15:archdischild-2019-318545.

Isolated disproportionately raised alkaline phosphatase: Should we worry?

Lee YL, et al. J Paediatr Child Health. 2020 Jul 6.

Aplastic anaemia: Current concepts in diagnosis and management.

Furlong E, et al. J Paediatr Child Health. 2020 Jul;56(7):1023-1028

Little Doubt That CBT Works for Pediatric OCD.

Storch EA, et al. J Am Acad Child Adolesc Psychiatry. 2020 Jul;59(7):785-787.

Opioids or Steroids for Pneumonia or Sinusitis.

Phang KG, et al. Pediatrics. 2020 Jul 2:e20193690.

Diagnosis of rheumatic fever: the need for a better test.

Osowicki J, et al. Arch Dis Child. 2020 Jun 29:archdischild-2020-318970.

2. Original clinical studies

JULY HIGHLIGHTS

A randomized trial of parenteral nutrition using a mixed lipid emulsion containing fish oil in infants of extremely low birth weight: Neurodevelopmental outcome at 12 and 24 months corrected age, a secondary outcome analysis.

Thanhaeuser M, et al. J Pediatr. 2020 Jun 23.

Stop, think SCORTCH: rethinking the traditional ‘TORCH’ screen in an era of re-emerging syphilis.

Penner J, et al. Arch Dis Child. 2020 Jun 25.

Loop-mediated isothermal amplification for the early diagnosis of invasive meningococcal disease in children.

Waterfield T, et al. Arch Dis Child. 2020 Jun 25.

Incidence of SARS-CoV-2 vertical transmission: a meta-analysis.

Goh XL, et al. Arch Dis Child Fetal Neonatal Ed. 2020 Jun 25.

Paediatric femur fractures-the value of contextual information on judgement in possible child abuse cases: are we bias?

Loos MHJ, et al. Eur J Pediatr. 2020 Jun 17.

Metabolic risk factors in children with kidney stone disease: an update.

Spivacow FR, et al. Pediatr Nephrol. 2020 Jun 20.

Association of Chorioamnionitis with Cerebral Palsy at Two Years after Spontaneous Very Preterm Birth: The EPIPAGE-2 Cohort Study.

Maisonneuve E, et al. J Pediatr. 2020 Jul;222:71-78.e6.

Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound.

Tusor N, et al. Eur J Pediatr. 2020 Jun 26.

Early Puberty and Telomere Length in Preadolescent Girls and Mothers.

Koss KJ, et al. J Pediatr. 2020 Jul;222:193-199.e5.

National Variations in Recent Trends of Sudden Unexpected Infant Death Rate in Western Europe.

de Visme S, et al. J Pediatr. 2020 Jun 22.

Parenting Interventions in Pediatric Primary Care: A Systematic Review.

Smith JD, et al. Pediatrics. 2020 Jun 24.

Risk Factors for Severe Anaphylaxis in Children.

Olabarri M, et al. J Pediatr. 2020 Jun 13.

Epileptic Spasms in Patients With Down Syndrome: Experiences From Caregivers.

Kats DJ, et al. J Child Neurol. 2020 Jun 25:883073820932770.

Antenatally detected urinary tract dilatation: a 12-15-year follow-up.

Herthelius M, et al. Pediatr Nephrol. 2020 Jun 23.

Nasal insertion depths for neonatal intubation.

Maiwald CA, et al.Arch Dis Child Fetal Neonatal Ed. 2020 Jun 22.

Body mass index rebound, weight gain in puberty, and risk of cardiovascular disease.

Arisaka O, et al. J Pediatr. 2020 Jun 19.

How to improve CPAP failure prediction in preterm infants with RDS: a pilot study.

Radicioni M, et al. Eur J Pediatr. 2020 Jun 19.

Reference values for the external genitalia of full-term and pre-term female neonates.

Castets S, et al. Arch Dis Child Fetal Neonatal Ed. 2020 Jun 19.

Corticosteroids to prevent kidney scarring in children with a febrile urinary tract infection: a randomized trial.

Shaikh N, et al. Pediatr Nephrol. 2020 Jun 15.

Ambulatory blood pressure abnormalities in children with migraine.

Yılmaz S, et al. Pediatr Nephrol. 2020 Jun 17.

Long-term follow-up of coronary artery lesions in children in Kawasaki syndrome.

Maccora I, et al. Eur J Pediatr. 2020 Jun 15.

Infant With SARS-CoV-2 Infection Causing Severe Lung Disease Treated With Remdesivir.

Frauenfelder C, et al. Pediatrics. 2020 Jun 18.

Reducing Abdominal Radiographs to Diagnose Constipation in the Pediatric Emergency Department.

Moriel G, et al. J Pediatr. 2020 Jun 14.

Cardiovascular Outcomes in Young Adulthood in a Population-Based Very Low Birth Weight Cohort.

Harris SL, et al. J Pediatr. 2020 Jun 14.

Early Use of Antibiotics Is Associated with a Lower Incidence of Necrotizing Enterocolitis in Preterm, Very Low Birth Weight Infants: Neomune-NeoNutriNet Cohort Study.

Li Y, et al. J Pediatr. 2020 Jun 14.

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection: A Multi-institutional Study from New York City.

Kaushik S, et al. J Pediatr. 2020 Jun 14.

Reductions in Parent Interest in Receiving Antibiotics Following a 90-Second Video Intervention in Outpatient Pediatric Clinics.

Goggin K, et al. J Pediatr. 2020 Jun 15.

Growth curves: The experiences of Canadian paediatricians in their first 5 years of independent practice.

Schrewe B, , et al. Paediatr Child Health. 2020 Jun;25(4):235-240.

Pacifiers and the reduced risk of sudden infant death syndrome.

Smith RW, et al. Paediatr Child Health. 2020 Jun;25(4):205-206.

Improving HPV Vaccination Rates: A Stepped-Wedge Randomized Trial.

Perkins RB, et al. Pediatrics. 2020 Jun 15.

Parental Hesitancy About Routine Childhood and Influenza Vaccinations: A National Survey.

Kempe A, et al. Pediatrics. 2020 Jun 15.

Covid-19, Kawasaki disease, and Multisystem Inflammatory Syndrome in Children.

Bassareo PP, et al. J Pediatr. 2020 Jun 12.

Neonatal antibiotics and infantile colic in term born infants.

Kamphorst K, et al. J Pediatr. 2020 Jun 12.

Effect of Nonintervention vs Oral Ibuprofen in Patent Ductus Arteriosus in Preterm Infants: A Randomized Clinical Trial.

Sung SI, et al. JAMA Pediatr. 2020 Jun 15.

Typical RSV cough: myth or reality? A diagnostic accuracy study.

Binnekamp M, et al. Eur J Pediatr. 2020 Jun 13.

Validation of the Early Language Scale.

Visser-Bochane MI, et al. Eur J Pediatr. 2020 Jun 13.

Multicenter Analysis of Acquired Undescended Testis and Its Impact on the Timing of Orchidopexy.

Boehme P, et al. J Pediatr. 2020 Jun 9.

A Prospective Study of Costs Associated with the Evaluation of β-Lactam Allergy in Children.

Sobrino M, et al. J Pediatr. 2020 Jun 9.

Novel Coronavirus Infection in Febrile Infants Aged 60 Days and Younger.

McLaren SH, et al. Pediatrics. 2020 Jun 11.

Recurrent sudden unexpected death in infancy: a case series of sibling deaths.

Garstang JJ, et al. Arch Dis Child. 2020 Jun 11.

Polyethylene Glycol Dosing for Constipation in Children under 24 months: A Systematic Review.

Rachel H, et al. J Pediatr Gastroenterol Nutr. 2020 Jun 9.

The Role of the Placenta in Perinatal Stroke: A Systematic Review.

Roy B, et al. J Child Neurol. 2020 Jun 9:883073820929214.

Mental Health Problems and Risk of Suicidal Ideation and Attempts in Adolescents.

Orri M, et al. Pediatrics. 2020 Jun 8.

Primum non nocere: lingual frenotomy for breastfeeding problems, not as innocent as generally accepted.

Van Biervliet S, et al. Eur J Pediatr. 2020 Jun 6.

Group B Streptococcus Meningitis in an Infant with Respiratory Syncytial Virus Detection.

Barton MS, et al. J Pediatr. 2020 Jun 4.

Faecal calprotectin levels during the first year of life in healthy children.

Günaydın Şahin BS, et al. J Paediatr Child Health. 2020 Jun 5.

Parent-Child Agreement on Postconcussion Symptoms in the Acute Postinjury Period.

Gagnon I, et al. Pediatrics. 2020 Jun 4.

Does topical local anaesthesia reduce the pain and distress of nasogastric tube insertion in children?

Mort DO, et al. Arch Dis Child. 2020 Jul;105(7):697-700.

Effect of ondansetron on vomiting associated with acute gastroenteritis in a developing country: a meta-analysis.

Wu HL, Zhan X. Eur J Pediatr. 2020 Jun 3.

Comparison of the Prevalence of Infantile Colic Between Pediatric Migraine and Other Types of Pediatric Headache.

Levinsky Y, et al. J Child Neurol. 2020 Jun 3:883073820924264.

Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in New York City, New York.

Zachariah P, et al. JAMA Pediatr. 2020 Jun 3:e202430.

Using Mobile Device Sampling To Objectively Measure Screen Use in Clinical Care.

Milkovich LM, et al. Pediatrics. 2020 Jun 1.

Young Children’s Use of Smartphones and Tablets.

Radesky JS, et al. Pediatrics. 2020 Jun 1.

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review.

Paterson RS, et al. Pediatrics. 2020 Jun;145(Suppl 3):S243-S268.

Continuous Glucose Monitoring in Adolescent, Young Adult, and Older Patients With Type 1 Diabetes.

Agarwal S, et al. JAMA. 2020 Jun 16;323(23):2384-2385.

AUGUST HIGHLIGHTS

Anticonvulsant long-term and rescue medication: The children’s perspective.

Woltermann S, et al. Eur J Paediatr Neurol. 2020 Jul 14:

Chronic diarrhoea in children: A practical algorithm-based approach.

Shankar S, et al. J Paediatr Child Health. 2020 Jul;56(7):1029-1038

Transmission of SARS-CoV-2 by Children.

Merckx J, et al. Dtsch Arztebl Int. 2020 Jul 21;117(33-34):553-560.

Does selective evaluation of gastric aspirates in preterm infants influence time to full enteral feeding?

Kennedy L, et al. J Paediatr Child Health. 2020 Jul;56(7):1150-1154.

Severe motion sickness in infants and children.

Lipson S, et al. Eur J Paediatr Neurol. 2020 Jul 10:S1090-3798(20)30118-5

Risk Factors for Orthostatic Hypertension in Children.

Hu Y, et al. J Pediatr. 2020 Jul 12:S0022-3476(20)30873-8.

Distress in Infants and Young Children: Don’t Blame Acid Reflux.

Salvatore S, et al. J Pediatr Gastroenterol Nutr. 2020 Jul 6.

As soon as possible in IgE-cow’s milk allergy immunotherapy.

Boné Calvo J, et al. Eur J Pediatr. 2020 Jul 11.

COVID-19: minimising contaminated aerosol spreading during CPAP treatment.

Donaldsson S, et al. Arch Dis Child Fetal Neonatal Ed. 2020 Jul 15:fetalneonatal-2020-319431.

A Comprehensive Clinical Genetics Approach to Critical Congenital Heart Disease in Infancy.

Shikany AR, et al. Pediatr. 2020 Jul 24:S0022-3476(20)30964-1

The association between enteric viruses and necrotizing enterocolitis.

Cheng C, et al. Eur J Pediatr. 2020 Jul 22

Intrauterine Device Use in Adolescents With Disabilities.

Schwartz BI, et al. Pediatrics. 2020 Jul 23:e20200016.

Social cognition and executive functions in children and adolescents with focal epilepsy.

Operto FF, et al. Eur J Paediatr Neurol. 2020 Jul 13:S1090-3798(20)30127-6.

Association Between Community Water Fluoridation and Severe Dental Caries Experience in 4-Year-Old New Zealand Children.

Schluter PJ, et al. JAMA Pediatr. 2020 Jul 27

Neurodevelopmental outcomes after moderate to severe neonatal hypoglycemia.

Helleskov AR, et al. Eur J Pediatr. 2020 Jul 14.

Associations of Birth Weight for Gestational Age with Child Health and Neurodevelopment among Term Infants: A Nationwide Japanese Population-Based Study.

Tamai K, et al. J Pediatr. 2020 Jul 5:S0022-3476(20)30829-5

Household Transmission of SARS-CoV-2 from Adults to Children.

Yung CF, et al. J Pediatr. 2020 Jul 4:S0022-3476(20)30852-0.

Use of Automated Office Blood Pressure Measurement in the Evaluation of Elevated Blood Pressures in Children and Adolescents.

Hanevold CD, et al. J Pediatr. 2020 Jul 4:S0022-3476(20)30762-9.

Coronary Dilatation and Endothelial Inflammation in Neonates born to mothers with Preeclampsia.

Lin IC, et al. J Pediatr. 2020 Jul 23:S0022-3476(20)30958-6.

Automated Office Blood Pressure Measurement for the Diagnosis of Hypertension.

Filler G, et al. J Pediatr. 2020 Jul 23:S0022-3476(20)30965-3

Effects of Neonatal Hyperglycemia on Retinopathy of Prematurity and Visual Outcomes at 7 Years of Age: A Matched Cohort Study.

Leung M, et al. J Pediatr. 2020 Aug;223:42-50.e2

Evaluation of Chest Radiographs of Children with Newly Diagnosed Acute Lymphoblastic Leukemia.

Smith WT, et al. J Pediatr. 2020 Aug;223:120-127.e3.

Delayed vs Immediate Cord Clamping Changes Oxygen Saturation and Heart Rate Patterns in the First Minutes after Birth.

Padilla-Sánchez C, et al. J Pediatr. 2020 Jul 22:S0022-3476(20)30902-1

Early surfactant replacement guided by lung ultrasound in preterm newborns with RDS: the ULTRASURF randomised controlled trial.

Rodriguez-Fanjul J, et al. Eur J Pediatr. 2020 Jul 24:1-8.

Lung ultrasound-guided surfactant administration: time for a personalized, physiology-driven therapy.

Raimondi F, de Winter JP, et al. Eur J Pediatr. 2020 Jul 24

Do otherwise well, healthy children with palpable cervical lymph nodes require investigation with neck ultrasound?

Paddock M, et al. Arch Dis Child. 2020 Jul 24:archdischild-2020-319648

Outbreak of anorexia nervosa admissions during the COVID-19 pandemic.

Haripersad YV, et al. Arch Dis Child. 2020 Jul 24:archdischild-2020-319868.

Frequency of Multifocal Disease and Pyogenic Arthritis of the Hip in Infants with Osteoarticular Infection in Three Neonatal Intensive Care Units.

Rubin LG, et al. J Pediatr. 2020 Jul 21:S0022-3476(20)30954-9.

Effect of Cognitive and Physical Rest on Persistent Post-Concussive Symptoms Following a Pediatric Head Injury.

Root JM, et al. J Pediatr. 2020 Jul 20:S0022-3476(20)30906-9

Celiac Disease in Children with Functional Constipation: A School Based Multicity Study.

Fifi AC, et al. J Pediatr. 2020 Jul 19:S0022-3476(20)30951-3.

Association between NICU Admission and Supine Sleep Positioning, Breastfeeding, and Postnatal Smoking among Mothers of Late Preterm Infants.

Hannan KE, et al. J Pediatr. 2020 Jul 19:S0022-3476(20)30952-5.

Test Strategies to Predict Inflammatory Bowel Disease Among Children With Nonbloody Diarrhea.

Van de Vijver E, et al. Pediatrics. 2020 Jul 21:e20192235.

Effect of cumulative dexamethasone dose in preterm infants on neurodevelopmental and growth outcomes: a Western Australia experience.

Buchiboyina AK, et al. Arch Dis Child Fetal Neonatal Ed. 2020 Jul 20:fetalneonatal-2020-319147.

Predicting Nasal High-Flow Treatment Success in Newborn Infants with Respiratory Distress Cared for in Non-Tertiary Hospitals.

McKimmie-Doherty M, et al. J Pediatr. 2020 Jul 14:S0022-3476(20)30882-9.

Neonatal Candida auris infection: Management and prevention strategies – A single centre experience.

Chandramati J, et al. J Paediatr Child Health. 2020 Jul 16.

Flattening the (BMI) Curve: Timing of Child Obesity Onset and Cardiovascular Risk.

Armstrong S, et al. Pediatrics. 2020 Jul 6:e20201353

Body Mass Index From Early to Late Childhood and Cardiometabolic Measurements at 11 to 12 years.

Lycett K, et al. Pediatrics. 2020 Jul 6:e20193666

Parent Technology Use, Parent-Child Interaction, Child Screen Time, and Child Psychosocial Problems among Disadvantaged Families.

Wong RS, et al. J Pediatr. 2020 Jul 3:S0022-3476(20)30849-0

Being Mindful About Follow-up Care After Pediatric Hospitalization for Bronchiolitis.

Berry JG, et al. JAMA Pediatr. 2020 Jul 6:e201945.

Multivariate risk and clinical signs evaluations for early-onset sepsis on late preterm and term newborns and their economic impact.

Benincasa BC, et al. Eur J Pediatr. 2020 Jul 4.

Time to positive blood culture in early onset neonatal sepsis: A retrospective clinical study and review of the literature.

Marks L, et al. J Paediatr Child Health. 2020 Jul 3

Neonatal bacterial meningitis versus ventriculitis: a cohort-based overview of clinical characteristics, microbiology and imaging.

Peros T, et al. Eur J Pediatr. 2020 Jul 3

The utility of ketones at triage: a prospective cohort study.

Durnin S, et al. Arch Dis Child. 2020 Jul 3:archdischild-2019-318425.

Duration of Respiratory and Gastrointestinal Viral Shedding in Children With SARS-CoV-2: A Systematic Review and Synthesis of Data.

Xu CLH, et al. Pediatr Infect Dis J. 2020 Jun 30.

Clinical Severity of Gastroenteritis in Children Hospitalized With Rotavirus Infection Before and Post Introduction of a National Rotavirus Vaccination Program in Australia.

Clarke M, et al. Pediatr Infect Dis J. 2020 Jun 30.

Grasping Gaming: Parent Management Training for Excessive Videogame Use in Children.

Hughes T, et al. J Am Acad Child Adolesc Psychiatry. 2020 Jul;59(7):794-796.

Internet-Related Behaviors and Psychological Distress Among Schoolchildren During COVID-19 School Suspension.

Chen IH, et al. J Am Acad Child Adolesc Psychiatry. 2020 Jun 26:S0890-8567(20)30385-3.

Obesity is associated with severe clinical course in children with Henoch-Schonlein purpura.

Dundar HA, et al. Pediatr Nephrol. 2020 Jun 29.

Effect of opaque wraps for pulse oximeter sensors: randomised cross-over trial.

Kannan Loganathan P, et al. Arch Dis Child Fetal Neonatal Ed. 2020 Jul 1:fetalneonatal-2020-319049.

E-cigarette Marketing Regulations and Youth Vaping: Cross-Sectional Surveys, 2017-2019.

Hammond D, et al. Pediatrics. 2020 Jul;146(1):e20194020.

Symptom Score: A New Instrument to Assess Orthostatic Intolerance in Children and Adolescents.

Cai H, et al. J Child Neurol. 2020 Jun 29:883073820936025.

Antibiotics for Childhood Pneumonia – Do We Really Know How Long to Treat?

Chang AB, et al. N Engl J Med. 2020 Jul 2;383(1):77-79.

Amoxicillin for 3 or 5 Days for Chest-Indrawing Pneumonia in Malawian Children.

Ginsburg AS, et al. N Engl J Med. 2020 Jul 2;383(1):13-23.

Multisystem Inflammatory Syndrome in U.S. Children and Adolescents.

Feldstein LR, et al. N Engl J Med. 2020 Jul 23;383(4):334-346.

Childhood Multisystem Inflammatory Syndrome – A New Challenge in the Pandemic.

Levin M. N Engl J Med. 2020 Jul 23;383(4):393-395.

3. Guidelines and Best Evidence

JULY HIGHLIGHTS

Perineal Groove: An Anorectal Malformation Network, Consortium Study.

Samuk I, et al. J Pediatr. 2020 Jul;222:207-212.

The Implementation of Screening for Adverse Childhood Experiences in Pediatric Primary Care.

DiGangi MJ, et al. J Pediatr. 2020 Jul;222:174-179.e2.

Helicobacter Pylori Infection in Pediatric Patients Living in Europe: Results of the EuroPedHP Registry 2013-2016.

Kori M, et al. J Pediatr Gastroenterol Nutr. 2020 Jun 11.

Updated Strategies for Pulse Oximetry Screening for Critical Congenital Heart Disease.

Martin GR,  et al. Pediatrics. 2020 Jun 4.

AUGUST HIGHLIGHTS

Barrier Protection Use by Adolescents During Sexual Activity.

Grubb LK; COMMITTEE ON ADOLESCENCE. Pediatrics. 2020 Jul 20:e2020007237.

Long-Acting Reversible Contraception: Specific Issues for Adolescents.

Menon S; COMMITTEE ON ADOLESCENCE. Pediatrics. 2020 Jul 20:e2020007252.

Nasal swab as preferred clinical specimen for COVID-19 testing in children.

Palmas G, et al. Pediatr Infect Dis J. 2020 Jul 1.

What is the effectiveness and safety of different interventions in the management of drooling in children with cerebral palsy?

Khajuria S, et al. Arch Dis Child. 2020 Jun 30:archdischild-2020-319309

4. Case Reports

JULY HIGHLIGHTS

A case of cannabinoid hyperemesis syndrome highlighting related key paediatric issues.

Leveille CF, et al. Paediatr Child Health. 2020 Jun;25(Suppl 1):S7-S9.

New Onset Chorea in a Previously Healthy 7-Year-Old.

Delaney MA, et al. J Pediatr. 2020 Jun 10.

An 8-Year-Old Boy With Fever, Splenomegaly, and Pancytopenia.

Offenbacher R, et al. Pediatrics. 2020 Jun 12.

Case 5-2020: A 32-Day-Old Male Infant with a Fall.

Rothstein P.  N Engl J Med. 2020 Jun 11;382(24):2381.

Elevated Serum Creatinine: But Is It Renal Failure?

Wong Vega M, et al. Pediatrics. 2020 Jun 17.

AUGUST HIGHLIGHTS

Rare cutaneous manifestations of parvovirus B19 infection in a child.

Yan J, et al. J Paediatr Child Health. 2020 Jul 28. doi: 10.1111/jpc.15030.

A Toddler with Sudden Scrotal Swelling.

Trombetta A, et al. J Pediatr. 2020 Aug;223:220-221

Evolving Peri-Anal Mass in 2-Year-Old.

Yang A, et al. Pediatr Infect Dis J. 2020 Jun 16.

Myocarditis in a 16-year-old boy positive for SARS-CoV-2.

Gnecchi M, et al. Lancet. 2020 Jun 27;395(10242):e116

Case 20-2020: A 7-Year-Old Girl with Severe Psychological Distress after Family Separation.

Gartland MG, et al. N Engl J Med. 2020 Jun 25;382(26):2557-2565.

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

Join us at DFTBLive

Cite this article as:
Team DFTB. Join us at DFTBLive, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.28658

Although the DFTB team had been planning and looking forward to hosting DFTB20 in Brisbane this year, COVID-19 has changed many things including our ability to physically gather or even take leave from work. In response, we have called on our wonderful community in order to develop a brand new program for a special one-day conference  – DFTB Live + Connected (#DFTBLive) – a one-day digital extravaganza with 26 international speakers. You will hear from families, nurses, doctors, allied health professionals, a screenwriter, and a linguistics expert, all sharing expertise relevant to your clinical practice. To view the program check out DFTBLive.com

In addition to the stellar program filled with the latest research, science, and story in paediatric acute care, we haven’t forgotten to add some unique DFTB treats with musical performances from the talented Suman Biswas, Coldspray, EDMusos and even some of the DFTB community.

DFTB Live + Connected

The conference will be streamed on a special conference platform, HopIn, which allows for a stage, breakout discussion rooms, and one-on-one chat networking. It will run from 0600-1600 UK time / 1500-0100 Sydney time on Wednesday, August 26th. We have done our best to make it as accessible as possible with a ticket price of only $200 AUD inclusive of two-months access to rewatch talks post-conference. Thanks to a partnership with ACEM we are offering free access to anyone registering who is working in a LMIC country.

Consider registering with your friends and enjoying the conference physically in a small group “watch party” – stay tuned for a few ideas on how to do this. For those of you who were registered for DFTB20 and have held onto your tickets in preparation for DFTB21 – thank you for your continuing support. You should have received registration details for free access toDFTBLive via email. If you have any issues feel free to contact hello@dontforgetthebubbles.com

If you are passionate about paediatric care, want to hear about cutting edge research and practice or just want to spend some time catching up amongst a group of clinicians who place children at the heart of healthcare then click here to register.  We can’t wait to see you there!