Aims: To assess the spontaneous resolution of neonatal nephrocalcinosis and its long term effects on renal function. Methods: Fourteen very low birthweight preterm babies with nephrocalcinosis were followed up at 5-7 years of age; 14 controls were matched for sex, gestation, and birth weight. Height, weight, blood pressure, and renal symptomatology were recorded, and a renal ultrasound scan was performed. Early morning urine osmolality and creatinine ratios of albumin, phosphate, calcium, oxalate and b microglobulin were determined. Urea and electrolytes in the study group were determined, and glomerular filtration rate (GFR) and TmP/GFR (tubular reabsorption of phosphate per GFR) were calculated. Statistical analysis was performed on a group basis using the Mann-Whitney confidence interval. Results: Mean age was 6.9 years (range 5. 81-7.68). An early morning urine osmolality .700 mOsm/kg was achieved in all cases. In two cases and four controls, the calcium/creatinine ratio was .0.7 mmol/ mmol. In all cases, the GFR was normal (median 132.6 ml/min/1.73 m 2 (range 104.1-173.1)). Median TmP/GFR was 1.22 mmol/l (0.73-1.61), with two having levels below the normal range. These did not have persisting nephrocalcinosis. Nephrocalcinosis was found in three of the 12 cases scanned and one control. There were no significant differences in urine biochemistry. Conclusions: Resolution of nephrocalcinosis occurred in 75% of cases. No evidence was found to suggest that nephrocalcinosis is associated with renal dysfunction in the long term. There was evidence of hypercalciuria in the cases and controls, suggesting that prematurity may be a risk factor.
Background: A policy of regular neonatal weight monitoring was introduced to a geographically defined population in 2000. This was combined with targeted breast feeding support for infants reaching specified intervention thresholds. Aims: To look for evidence of compromise in breast feeding rates as a result of this policy change. Methods: Breast feeding rates at 10 days and 6 weeks were compared for this intervention population and two local non-intervention groups for the years 1999 and 2001. The data were analysed using Poisson regression analysis and the Z-test.Results: There was a 3.1% (95% CI 0.8% to 5.5%) rise in the deprivation corrected breast feeding rate at 6 weeks for the intervention population compared to an increase of 0.8% (95% CI -0.8% to 2.3%) for the combined control groups. Multivariate analysis showed that breast feeding rates were adversely influenced by deprivation, but were not significantly influenced by the intervention. Conclusion: No evidence was found to support claims that regular monitoring of newborn weight adversely affects breast feeding rates.
A 13-year-old girl presented to the emergency department with acute onset of chest pain, nausea and tremor. The patient denied drug ingestion, and urine toxicology was negative. ECG demonstrated sinus tachycardia, prolonged QTc (541 ms) and ST depression. Laboratory testing demonstrated metabolic acidosis, hypokalaemia, hypophosphataemia and hyperglycaemia. She was commenced on continuous cardiac monitoring and treated with intravenous fluids and electrolyte replacement. Presenting features and laboratory abnormalities resolved within 48 hours. The National Poisons Information Service and Clinical Biochemistry were integral to her management, advising the clinical team on the likeliest aetiology. Five weeks after discharge, urine toxicology, using mass spectrometry, identified clenbuterol. Clenbuterol is an oral β2-agonist with anabolic and lipolytic effects that is misused as a performance and image enhancing drug. Clinicians must be aware of the increasing availability of these drugs and their potential for causing harm in children and adolescents.
AimsTo identify:1. The most common presenting complaints of infants that have urine samples sent for microscopy and culture2. If dipstick analysis is a reliable investigation in diagnosing urinary tract infection in infants under the age of 13. If urine microscopy is a reliable investigation in diagnosing urinary tract infection in infants under the age of 1MethodRetrospective case note review of all patients under the age of 1 with urine samples sent for culture from Children’s ward in RAH between January and March 2016.Results98 samples included in study.84 patients (49 male, 35 female).26 infants (31%) had full septic screen and commenced on IV antibiotics as per local guidelines.94 samples obtained by clean catch urine, 1 sample from in- and-out catheter and 1 suprapubic aspiration.48% of patients presented with pyrexia and 18% with vomiting.33 patients had no documented urinalysis, 5 samples were positive.12 samples were positive for leucocytes +/ nitrites, 33% had a positive culture.ConclusionsMost common presenting complaint in infants that have a urine sample sent is temperature.Difficult to compare data due to differences in numbers of negative and positive results.Dipstick analysis is not a sensitive measure of infection in this age group.The majority of negative cultures will have either ‘scanty or nil’ organisms on microscopy.58% of positive cultures have ‘scanty’ cell counts likely to get false negatives.A sample with numerous cells and numerous organisms is likely to be a positive UTI.The majority (76%) of negative cultures have scanty or nil on cell count.RecommendationsBetter documentation of urinalysis results on the ward.Further data needs to be analysed as small sample included in this study.Further audit after feedback to ward staff to identify improvement in urinalysis documentation.
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