BackgroundFrom September 2015 babies born on or after 1/7/15 are being offered the MenB (meningococcal group B) vaccine, bexsero, as part of their routine immunisation schedule. The vaccine is given at 2, 4 and 12 months.Fever is a common and predictable response to vaccinations. In clinical studies when bexsero was given alone, the frequency of fever was 44%-59%. This number rose to between 69–79% when bexsero is co-administered with routine vaccinations.Babies are routinely being given paracetamol at the time of immunisation and parents advised to administer two further of doses at 4–6 hly intervals.Other very common side effects include loss of appetite, sleepiness and irritability.AimI aimed to quantify the number of infants presenting to ED with fever post-immunisations and collect data on how they are being managed.MethodA retrospective analysis of records was undertaken between 1/9/15–14/10/15 to identify those <3mths of age presenting with problems relating to recent immunisation.Results37 infants were seen over the 6 week period with parental concern of fever. 8 had recently received the MenB vaccine. 5 infants presented within the first 12hrs and the rest 12–18hrs post immunisation.All 8 were given paracetamol prior to attendance.3 babies were febrile >38 degrees on arrival. 4 babies were discharged after review including one with a documented temperature. 4 were admitted to hospital, 3 of whom underwent a full septic screen including LP and were commenced on IV antibiotics. Investigations including CSF, blood and urine cultures for all 3 of these infants were negative and their fever was attributed to recent vaccinations.ConclusionThe clinical management of babies presenting with fever post-immunisations ranged from reassurance to full septic screen and hospital admission. Isolated fever in an otherwise well baby may be assessed fit for discharge. However, when combined with other common side effects such as irritability and poor feeding, investigation to exclude alternative cause for symptoms may be deemed necessary. This must be assessed on a case by case basis but the author suggests admission for observation be considered an appropriate management strategy for "well" infants.
BackgroundHead injury is a common presenting complaint to emergency departments and can generate clinical concern regarding non accidental injury (NAI) in young children. Clinicians are wary of exposing young children to unnecessary radiation but must balance this risk with their duty to protect the child and recognise abuse.ObjectiveTo review all radiological imaging for trauma related head injuries in under-2 year olds with the aim of establishing the incidence of non-accidental injury and identify associated features that may aid clinical decision making.DesignA single-centre retrospective note review was conducted over a 3 year period (01/01/12 – 01/01/2015) of children<2 years of age who presented to a tertiary paediatric hospital (RHSC, Glasgow) and received cranial imaging. Cases were identified using the PACS reporting system.Results75 cases were identified as trauma related neuroimaging over the study period and were subject to a detailed case note review. Median age was 39 weeks. There was a male predominance of 65%. All 75 patients underwent CT head as their primary mode of trauma imaging.Abnormal findings were reported in 79% with the most common finding being unilateral parietal skull fracture. 44% of those with positive findings on CT underwent a skeletal survey and 36% had ophthalmology review. 31% had a social work strategy meeting prior to discharge.17% of patients with positive findings on CT head were deemed to have sustained their injury secondary to abuse. None of these injuries were witnessed. Median age was 16 weeks. 70% of inflicted injuries had a complex skull fracture compared to 18% for those deemed accidental. 20% of the NAI group were previously known to social work compared to 3% in the accidental group.ConclusionCT is the modality of choice for suspected skull fracture in RHSC, Glasgow. Younger age, unwitnessed injury, existing social work support and complex skull fracture were all associated more commonly with abusive injuries in this 3 year review. Our data has contributed to a larger UK study aiming to determine national variation in practice and deriving a clinical decision making tool to exclude/diagnose NAI as the cause of skull fracture.
ObjectiveTo document the clinical features and management of infants presenting with fever after their first meningococcal B vaccination, and develop guidance for clinicians.DesignA prospective case series over a 12 month period.SettingThe Royal Hospital for Children Glasgow, a tertiary paediatric hospital.PatientsInfants≤3 months of age who had received their first set of immunisations (including Bexsero) within the preceding 72 hours and reported fever.ResultsNinety two infants met the inclusion criteria, accounting for 0.78% of the local vaccinated population. The most commonly described features were poor feeding, sleepiness and irritability. Sixty six patients (72%) were admitted to hospital. Median CRP was 12 mg/L and median WCC was 16 × 109/L.Fifteen patients (16%) had a lumbar puncture and were commenced on antibiotics. There was one confirmed bacterial infection in an infant who had presented with fever starting 54 hours after immunisation. All other microbiology samples were negative. There were no cases of missed serious bacterial infection (SBI) in those patients observed or discharged.ConclusionPost-immunisation fever is a common presenting problem to the paediatric emergency department. Based on our findings, routine investigations are not warranted if the infant appears well on examination. Where other common side effects are present and there is clinical concern, a period of observation may be a reasonable option. We suggest selective use of investigations, especially inflammatory markers, that are unlikely to discriminate between serious bacterial infection and post-immunisation response. We advocate extra caution in infants presenting with fever more than 48 hours after immunisation.
Aim To determine if staff in a general paediatric ward are familiar with adrenaline auto-injector devices and can demonstrate correct use. Method Selections of medical, nursing and Health care assistants were approached over a 48hr period. 25 people were recruited in total. Each person was interviewed individually and asked the following questions: Can you identify this device? (shown an EpiPen®) What drug does this device contain and when it should be used? Demonstrate correct use using an EpiPen® training device (Based on the following 6 steps) Remove cap Grip device correctly Identify correct site for injection Activate device Hold in place for 10 seconds Rub injection site Results Figure 1 shows participants by role in the department. Figure 2 shows the number of participants who correctly demonstrated each of the 6 steps. Incorrect grip in 3 participants would have resulted in self-injection into the thumb if we had been not been dummy training devices. This is associated with morbidity for the member of staff with a risk of dignital ischaemia, and delay in treatment for the patient. Conclusion Safe use of medical devices is a part of GMC good medical practice guidelines. Staff in a paediatric unit that treats children with allergies should be familiar with these devices and trained to use them in emergency situations. Although most staff in a general paediatric ward could identify an adrenaline auto-injector device and know when is appropriate to use it, the majority could not demonstrate correct use of the device. Following a short training session, 100% of subjects were able to demonstrate correct technique. I conclude that through basic demonstration and training, adrenaline auto-injectors can be used safely and appropriately.
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