• Acute functional deterioration in a child with cerebral palsy.

      Smyth, Elizabeth; Kaliaperumal, Chandrasekaran; Leonard, Jane; Caird, John; Department of Paediatrics, Children's University Hospital, Dublin, Republic of Ireland. (2012)
      We describe a case of acute functional deterioration in a 13-year-old girl with severe spastic diplegia (GMFCS III) and a new diagnosis of diffuse intrinsic pontine glioma (DIPG). She presented with acute deterioration in mobility and motor function over 1 month, which was associated with dysarthria, dysphagia and behavioural change. Her mother had noticed subtle functional deterioration over the 2 months prior to this. Her physiotherapist who was concerned about her acute functional deterioration referred her for emergency review. Neurological imaging revealed a diffuse pontine lesion consistent with DIPG. She was subsequently referred to oncology. She deteriorated further, clinically, over the next few days and following discussion with the team; her family opted for palliative treatment, given the poor prognosis associated with DIPG.
    • Aspergillus flavus sinusitis in ALL.

      Keane, Colm; Colreavy, Michael; Lynch, Maureen; O'Gorman, Peter; Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia. colm_keane@health.qld.gov.au (2009-02)
    • Chloral hydrate sedation in radiology: retrospective audit of reduced dose.

      Bracken, Jennifer; Heaslip, Ingrid; Ryan, Stephanie; Radiology Department, Children's University Hospital, Temple Street, Dublin, Ireland. jenny_bracken@hotmail.com (2012-03)
      Chloral hydrate (CH) is safe and effective for sedation of suitable children.
    • Clinical, genetic, and enzymatic characterization of P450 oxidoreductase deficiency in four patients.

      Sahakitrungruang, Taninee; Huang, Ningwu; Tee, Meng Kian; Agrawal, Vishal; Russell, William E; Crock, Patricia; Murphy, Nuala; Migeon, Claude J; Miller, Walter L; Department of Pediatrics, University of California San Francisco, San Francisco, California 94143, USA. (2009-12)
      P450 oxidoreductase (POR) deficiency causes disordered steroidogenesis; severe mutations cause genital ambiguity in both sexes plus the Antley-Bixler skeletal malformation syndrome, whereas mild mutations can cause adult infertility.
    • A comparison of pediatric forearm fracture reduction between conscious sedation and general anesthesia.

      McKenna, Paul; Leonard, Mike; Connolly, Paul; Boran, Sinead; McCormack, Damian; Department of Orthopaedics, Children's University Hospital, Temple Street, Dublin, Ireland. paulbmckenna@gmail.com (2012-09)
      The purpose of this study was to compare the outcomes of children whose fractures were manipulated with nitrous oxide with those fractures manipulated under a general anesthetic.
    • Ethnic differences in lipoprotein subclasses in obese adolescents: importance of liver and intraabdominal fat accretion.

      D'Adamo, Ebe; Northrup, Veronika; Weiss, Ram; Santoro, Nicola; Pierpont, Bridget; Savoye, Mary; O'Malley, Grace; Caprio, Sonia; Department of Pediatrics, Yale University, New Haven, CT, USA. (2010-09)
      Recently, the deleterious metabolic effects of visceral fat [visceral adipose tissue (VAT)] deposition were challenged, and liver fat emerged as having a key independent role in the modulation of cardiometabolic risk factors.
    • High normal fasting glucose level in obese youth: a marker for insulin resistance and beta cell dysregulation.

      O'Malley, G; Santoro, N; Northrup, V; D'Adamo, E; Shaw, M; Eldrich, S; Caprio, S; Department of Pediatrics, Yale University School of Medicine, 330 Cedar Street, PO Box 208064, New Haven, CT 06520, USA. (2010-06)
      A high but normal fasting plasma glucose level in adults is a risk factor for future development of type 2 diabetes mellitus and cardiovascular disease. We investigated whether normal fasting plasma glucose levels (<5.60 mmol/l) are associated with decreases in insulin sensitivity and beta cell function, as well as an adverse cardiovascular profile in obese youth.
    • Long-term results of an obesity program in an ethnically diverse pediatric population.

      Savoye, Mary; Nowicka, Paulina; Shaw, Melissa; Yu, Sunkyung; Dziura, James; Chavent, Georgia; O'Malley, Grace; Serrecchia, John B; Tamborlane, William V; Caprio, Sonia; et al. (2011-03)
      To determine if beneficial effects of a weight-management program could be sustained for up to 24 months in a randomized trial in an ethnically diverse obese population.
    • Patterns of Internet and smartphone use by parents of children attending a pediatric otolaryngology service.

      Glynn, Ronan W; O'Duffy, Fergal; O'Dwyer, Tadhg P; Colreavy, Micheal P; Rowley, Helena M (2013-05)
      To assess Internet use and the influence of smartphones on health-information seeking by parents and carers of children with ENT conditions.
    • Patterns of scald injuries in children--has anything changed?

      Yates, J; McKay, M; Nicholson, A J; Department of Paediatrics, Children's University Hospital, Temple St, Dublin 1. jenniferyates@rcsi.ie (2011-10)
      The objective was to study presentation patterns of scald injuries in children and suggest potential countermeasures to reduce these injuries. We retrospectively studied scald injuries in children attending an urban paediatric emergency department between January 1st and December 31st 2008. Data was extracted from our emergency department database using search terms 'burn', 'scald', 'other burn'. Scalds were analysed for; age at presentation, sex, time of presentation, causal agent, scald outcome and treatment required. Burns accounted for 280 (0.66%) of total attendees, 161 (57%) were scalds. 127 (79%) were under 5 years old (mean age 42 months). 104 (65%) were caused by hot beverages, 25 (16%) hot water and 16 (10%) hot food stuffs. 97 (60%) presented within 1 hour of injury. 40 (25%) received first aid. The most affected areas were upper limbs 79 (35%) and upper trunk 74 (33%). Overall 45 (28%) were discharged home requiring no further treatment, 9 (6%) were admitted to hospital and 101 (63%) attended dressing clinic or plastic surgery OPD. Our results are consistent with other studies and illustrate that the incidence and pattern of scald injuries have not changed over the past decade. Scalds will continue to be a significant cause of unintentional injury and morbidity among young children unless preventative strategies are devised and employed.
    • Pedestrian deaths in children--potential for prevention.

      Hamilton, K; Macken, W; McGarvey, C; Matthews, T G; Nicholson, A J (Irish Medical Journal, 2015-01)
      The National Paediatric Mortality Database was reviewed for the six year period 1st January 2006 to 31st December 2011 and all pedestrian deaths extracted, after review of available data the deaths were categorized as either traffic or non-traffic related. There were 45 child pedestrian fatalities in the period examined. Traffic related deaths accounted for 26 (58%) vs. 19 (42%) non-traffic related. Analysis of the deaths showed there was a male preponderance 28 (62%), weekend trend 22 (49%) with an evening 16 (35%) and summer peak 20 (44%). The highest proportion of deaths occurred in the 1-4 year age group 24 (53%), with 13 (28%) due to low speed vehicle rollovers, mainly occurring in residential driveways 8 (61%). Child pedestrian fatalities are highly preventable through the modification of risk factors including behavioural, social and environmental. Preventative action needs to be addressed, particularly in relation to non-traffic related deaths i.e, low speed vehicle rollovers.
    • A pilot study to profile the lower limb musculoskeletal health in children with obesity.

      O'Malley, Grace; Hussey, Juliette; Roche, Edna; Physiotherapy Department, Children's University Hospital, Dublin, Ireland. (2012)
      : Evidence suggests a negative effect of obesity on musculoskeletal health in children. A pilot study was undertaken to investigate the presence of musculoskeletal impairments in children with obesity and to explore the relationships among body mass index, physical activity, and musculoskeletal measures.
    • Pneumococcal meningitis: clinical outcomes in a pre-vaccine era at a Dublin paediatric hospital, 1999-2007.

      Lucey, J M; Gavin, P; Cafferkey, M; Butler, K M; Department of Paediatrics, Children's University Hospital, Temple Street, Dublin 1, Ireland. Juliette.Lucey@health.wa.gov.au (2011-03)
      To document the long-term outcomes of pneumococcal meningitis in children presenting to a Dublin paediatric hospital in the pre-pneumococcal conjugate vaccine (PCV7) era (1998-2007).
    • A prospective study of parents' compliance with their child's prescribed analgesia following tonsillectomy.

      Lennon, Paul; Amin, Mohamed; Colreavy, Michael P (2013-03)
      We conducted a prospective study to assess how well parents ensured that their children received their prescribed analgesia following tonsillectomy. Our study was based on 69 cases of tonsillectomy that were carried out at our tertiary pediatric care center. Postoperatively, all patients were prescribed paracetamol (acetaminophen) on the basis of their weight; the standard pediatric dosage of this agent at the time of our study was 60 mg/kg/day. The parents were telephoned 2 weeks postoperatively to assess their compliance with this regimen. Of the original 69 patients who had been recruited, 66 completed the study-35 girls and 31 boys, aged 2 to 15 years (mean: 7.0; median 5.5). According to the parents, only 15 children (22.7%) received our recommended 60-mg/kg/day dosage and were thus determined to be fully compliant. Overall, parents reported a wide variation in the amount of drug administered, ranging from 12.5 to 111.0 mg/kg/day (mean: 44.8), indicating that parents often underdose their children. We recommend that more emphasis be placed on weight-directed, parent-provided analgesia during the post-tonsillectomy period.
    • Radiological versus clinical evidence of malrotation, a tortuous tale--10-year review.

      Stephens, Linda Ruth; Donoghue, Veronica; Gillick, John; Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland. lrstephens80@gmail.com (2012-06)
      Malrotation is a common abnormality, often diagnosed in the neonatal period. Symptoms may be nonspecific and clinical signs of volvulus are often only seen in the late stages when there has been significant ischemic insult to the bowel. The gold standard diagnostic investigation is the upper gastrointestinal (UGI) contrast study. This study was designed to assess the incidence of negative laparotomy in patients with malrotation diagnosed on UGI contrast study and to identify the clinical signs and symptoms at presentation.
    • Serotype distribution of Streptococcus pneumoniae causing invasive disease in the Republic of Ireland.

      Vickers, I; Fitzgerald, M; Murchan, S; Cotter, S; O'Flanagan, D; Cafferkey, M; Humphreys, H; Epidemiology and Molecular Biology Unit and Irish Meningococcal and Meningitis Reference Laboratory, Children's University Hospital, Dublin, Ireland. imelda.vickers@cuh.ie (2011-05)
      The 7-valent pneumococcal conjugate vaccine (PCV7) was included in the routine infant immunization schedule in Ireland in September 2008. We determined the serotype of 977 S. pneumoniae isolates causing invasive disease between 2000-2002 and 2007-2008, assessed for the presence of the recently described serotype 6C and determined the susceptibility of isolates during 2007-2008 to penicillin and cefotaxime. Serotype 14 was the most common serotype during both periods and 7·7% of isolates previously typed as serotype 6A were serotype 6C. During 2000-2002 and 2007-2008, PCV7 could potentially have prevented 85% and 74% of invasive pneumococcal disease in the target population (i.e. children aged <2 years), respectively. The level of penicillin non-susceptibility was 17% in 2007-2008. Ongoing surveillance of serotypes is required to determine the impact of PCV7 in the Irish population and to assess the potential of new vaccines with expanded valency.
    • Should children with inherited metabolic disorders receive varicella vaccination?

      Varghese, M; Cafferkey, M; O'Regan, M; Monavari, A A; Treacy, E P; National Centre for Inherited Metabolic Disorders, Children's University Hospital, Dublin, Ireland. (2011-01)
      The aim was to determine the rate of varicella infection and complications in children with disorders of intermediary metabolism (IEM) between the ages of 1 and 16 years attending our national metabolic referral centre. Of 126 children identified, a response was received from 122. A history of previous varicella infection was identified in 64 cases (53%) and of varicella vaccination in 5 (4%). Fifty-three (43%) patients apparently did not have a history of clinical varicella infection. Of the 64 children with a history of varicella infection, five required hospitalisation for complications, including life-threatening lactic acidosis in one patient with mitochondrial disease and metabolic decompensation in four patients. In conclusion, varicella infection may cause an increased risk of metabolic decompensation in patients with IEMs. We propose that a trial of varicella vaccination be considered for this cohort of patients with monitoring of its safety and efficacy.
    • Tinzaparin is safe and effective in the management of hemodialysis catheter thrombosis.

      Quinlan, Catherine; Bates, Marie; Cotter, Melanie; Riordan, Michael; Waldron, Mary; Awan, Atif; Department of Nephrology, The Children's University Hospital, Dublin, Ireland. CathyQuinlan@mac.com (2012-08-27)
      Children on hemodialysis are at increased risk of thrombosis, especially when dialyzed via a central venous catheter (CVC); there are limited published data regarding the safety and efficacy of tinzaparin in this group. We conducted a retrospective chart review of all children in the National Pediatric Hemodialysis Centre for Ireland diagnosed with a CVC thrombus and treated with subcutaneous tinzaparin over a 10 year period. Seven children were treated with subcutaneous tinzaparin for 10 CVC thrombi. Tinzaparin was commenced at 175 IU/kg/day and the dose was titrated by measuring anti-factor Xa levels, aiming for levels of 0.3-1.0 IU/ml. Treatment was continued until resolution of the CVC thrombus. Restoration of normal flows during dialysis occurred within 3 days in all patients. There were no episodes of bleeding and all children tolerated the treatment well.