Category: Paeds

Paediatric Urine Results

Paediatric Urine Microscopy Interpretation and Action
Microscopy results
Interpretation
Pyuria and bacteriuria are both positive
Assume the baby or child has a urinary tract infection (UTI), ensure treatment with appropriate antibiotics
Pyuria is positive and bacteriuria is negative
Start antibiotic treatment if the baby or child has a symptoms or signs of a UTI
Pyuria is negative and bacteriuria is positive
Assume the baby or child has a UTI, ensure treatment with appropriate antibiotics
Pyuria and bacteriuria are both negative
Assume the baby or child does not have a UTI
IF UNDER 6 MONTHS OF AGE OR A NON E COLI BACTERIURIA ASK THE GP TO ARRANGE AN ULTRASOUND SCAN OF THE URINARY TRACT.
Pyuria: White cells on microscopy >50
Bacteriuria: Pure growth of a bacteria >105
If mixed growth or <105 presume bacteriuria is negative
Avoid prescribing nitrofurantoin liquid formulation as it is £250 per bottle!

Neonatal Seizures

Seizures are a common neurological emergency in the neonatal period, occurring in 1–5 per 1000 live births.1 The majority of neonatal seizures are provoked by an acute illness or brain insult with an underlying aetiology either documented or suspected, that is, these are acute provoked seizures (as opposed to epilepsy). They are also invariably focal in nature.

Clinical diagnosis of neonatal seizures is difficult. This is in part because there may be no, or very subtle, clinical features, and also because neonates frequently exhibit non-epileptic movements that can be mistaken for epileptic seizures.

If interested the full guideline pan Yorkshire Neonatal Seizure Guideline can be found here

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Alprostadil

To maintain or restore patency of the ductus arteriosus

Only to be used in infants who are ventilated or where ventilation is immediately available

Guideline-for-use-of-Dinoprostone-in-duct-dependent-CHD-1-8-3

 

DO NOT DELAY IN STARTING Alprostadil if: there is clinical
suspicion of duct dependent CHD while waiting for paediatric cardiology opinion OR echocardiogram, even when in-house echo facilities are present.

PDF: Alprostidil

 

Neonatal Resus

PUT OUT A NEONATAL CRASH CALL 

CRH – will result in at least a Neonatal SpR, SHO +/- a neonatal nurse.

HRI – may not generate a response. Consider a crash bleep to anaesthetics

CALL NEONATAL CONSULTANT (WILL ONLY GIVE ADVICE AS AT CRH)

CALL THE ED CONSULTANT

***Remember Grab Box***

Unless within the first few hours of life using the APLS algorithm is equally if not more appropriate

Paediatric Hypoglycaemia

Paediatric Hypoglycaemia (BM <2.6) is a relatively common presentation in the Emergency Department. However, if we don’t do the BM it’s easy to miss.

Hypoglycaemia in paediatric diabetic patients is managed separately – see here

Hypoglycaemia in neonates (<72 hours of life) also has specific management – see here (Flowcharts A + B)

Hypoglycaemia is generally caused by disruption in one of the following:

  • Carbohydrate intake
  • Carbohydrate absorption
  • Gluconeogenesis
  • Glycogenolysis

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DKA in Kids

Diabetic Ketoacidosis – remember in paediatrics this may be the 1st presentation of diabetes.

  • Fluid – are more considered than adults due to the risk of cerebral oedema
  • Insulin – WAIT – need 1hr of fluid first
  • Paeds – involve them early
  • USE the BSPED DKA Management flow charts, calculators and full guidelines for when electrolytes won’t play ball which are all linked below.

DKA Management Calculator (recommended by paediatrics)- HERE

DKA Management Flow Chart – HERE

Full CHT DKA Guideline – HERE

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Diabetic Hyperglycaemia (Kids)

Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)

Paeds have produced some advice to follow:

  1. Ketones over 0.6?
    • <0.6: Encourage fluids & food, may need an insulin correction
    • >0.6: ask Question 2
  2. Are there clinical features of DKA?
    • NO: Encourage fluids & food, decide Insulin correction, will need to be monitored
    • YES: Will need Paeds admission