Paediatrics

Paediatric and adult neurological point-of-care ultrasound: Review of the evidence, and the UK accreditation pathway (2026)

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Type of publication:

Journal article

Author(s):

Waraich M.; Zoica B.; Alexander E.; Stephens J.; Conway H.; Griksaitis M.; Kirk-Bayley J.; *Miller A.; Parulekar P.; Peck M.; Rubino A.; Wilkinson J.N.

Citation:

Journal of the Intensive Care Society. (no pagination), 2026. Date of Publication: 2026. [epub ahead of print]

Abstract:

Neurological emergencies such as stroke and traumatic brain injury are major contributors to morbidity and mortality in critically ill patients. These conditions frequently result in alterations in cerebral haemodynamics, including raised intracranial pressure, which require timely recognition and management to optimise outcomes. Neuro point-of-care ultrasound (NeuroPOCUS), incorporating transcranial Doppler (TCD), transcranial colour-coded duplex (TCCD) ultrasound, and optic nerve sheath diameter (ONSD) measurement, offers a non-invasive, bedside means of assessing cerebral physiology and is increasingly recognised as a valuable adjunct in neurocritical care. Despite the successful adoption of point-of-care ultrasound in critical care through established accreditation pathways such as FUSIC and CACTUS, the UK has lacked a dedicated framework for NeuroPOCUS. To address this gap, we have developed and launched a UK-specific NeuroPOCUS accreditation programme, combining structured theoretical teaching with supervised practical training. The pathway addresses the distinct needs of both paediatric and adult populations, combining theoretical learning with practical application. Core learning materials include neuroanatomy, Doppler principles, standardised insonation techniques, and interpretation of cerebral blood flow velocities and indices such as pulsatility (PI) and resistivity (RI). Supporting resources feature videos of transcranial colour-coded Duplex (TCCD) imaging in normal subjects and clinical case examples. Participants will complete a logbook of 50 supervised cases, facilitated by remote mentorship. A novel accreditation pathway provides an opportunity for further research into the use of NeuroPOCUS in neurocritical care. This article outlines the core techniques of NeuroPOCUS, the physiological insights it offers, key clinical applications, and the proposed accreditation pathway aimed at standardising practice and clinician training in the care of critically ill patients with neurological injury or dysfunction.

DOI: 10.1177/17511437261428885

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Improving Documentation on Paediatric Inpatient Drug Charts (2025)

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Type of publication:

Service improvement case study

Author(s):

*Dima Abdelhafiz, *Caitlyn Randles

Citation:

SaTH Improvement Hub, November 2025

SMART Aim:

I will improve the accuracy and completeness of weight documentation on paediatric drug cards by 30/09/25 as evidenced by a two cycle quality improvement project which shows an improvement in clear and accurate weight documentation on paediatric drug charts.

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Long-Term Outcomes of Coronary Artery Aneurysms in Children With Kawasaki Disease: A Systematic Review (2025)

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Type of publication:

Systematic Review

Author(s):

Shafy, Shoaib Syed Mohammed; Salavarria, Karla Andrea Calderon; Saleh, Sara; *Cuino, Ingrid; Nadeem, Sadaf; Perez, Rebeca Cristina Romero; Shetty, Arushi; Adhikari, Kedar; Khatter, Tanya; Arasada, Chinmayee; Moussa, Naji; Mbaekwe, Eziamaka; Horsaengchai, Panchanit; Ali, Ramsha.

Citation:

Cureus. 17(10):e94418, 2025 Oct.

Abstract:

Kawasaki disease (KD) is a systemic inflammation of the blood vessels seen in children. It is the leading cause of acquired heart disease. Coronary artery aneurysm (CAA) is the most concerning complication, associated with long-term morbidity and mortality. This systematic review examined long-term outcomes of CAAs in KD, with emphasis on regression, complications, and the role of medical and surgical interventions. A total of 21 studies involving 10,922 patients were reviewed. The incidence of CAAs ranged from 3%-27%, mostly affecting infants under 6 months. Small and moderate aneurysms regressed in the majority of cases (>80%), whereas giant aneurysms were less likely to regress. Complications included thrombosis, myocardial infarction, major adverse cardiac events, and cardiac death. Early treatment with intravenous immunoglobulin (IVIG) enhanced the likelihood of regression. Aneurysms in the left anterior descending artery were less likely to regress, suggesting an anatomical influence. Coronary artery bypass grafting was the most common surgical intervention. Early and aggressive management with IVIG, with escalation to steroids or biologics when required, remains the preferred approach. Surgical intervention is sought for giant or persistent aneurysms. These findings emphasize the importance of timely diagnosis, risk stratification, and the establishment of standardized guidelines to optimize long-term care and surveillance of patients with KD.

DOI: 10.7759/cureus.94418

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Pertussis Infection in Children QIP: Raising Awareness Amongst Clinicians (2025)

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Type of publication:

Conference abstract

Author(s):

*Khallaf L.; *Muniu S.; *Sakremath R.; *Lee S.

Citation:

Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2025. Glasgow United Kingdom. 110(Supplement 1) (pp A301-A302), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Why did you do this work? Pertussis is a highly infectious preventable disease caused by Bordetella pertussis. Young infants under 3 months of age remain at the highest risk of severe disease with 9 reported infant deaths this year in the United Kingdom.1 We aim to raise awareness about pertussis infection among clinicians in our Paediatric Department through education. What did you do? Educational sessions were delivered from February to March 2024. Data was collected using pre- and post-session questionnaires to assess clinician's knowledge. The questionnaire included symptoms, signs, management and complications of pertussis infection. A teaching presentation was given in the first cycle. In the second cycle, an informative poster was displayed throughout our department. Data was collected and analysed using Microsoft Excel. The effectiveness of the education tool delivered was evaluated. What did you find? There were 11 participants in the first cycle and 9 in the second cycle. All participants in cycle 1 understood pertussis infection and its complications and recognised the importance of exclusion from nursery/school. In cycle 2, all demonstrated knowledge of pertussis symptoms and knew it was a notifiable disease. In the first cycle, many participants, 63% (7 out of 11 participants), were unaware of the process for requesting a pertussis test in our department, which improved slightly to 55% (5 out of 9 participants) in the second cycle. Additionally, the rate of incorrect responses decreased between cycles for several topics: the incubation period of pertussis (54.5% in cycle 1 versus 33% in cycle 2), the appropriate timing for requesting the test (18% versus 11%), and knowledge of first-line antibiotics (36% versus 22%). The rate of incorrect responses increased between cycle 1 and cycle 2, rising from 27% to 33% for the need of prophylaxis treatment and 27% to 44% for the exclusion of asymptomatic contacts. Despite interventions, knowledge of the latter showed no improvement between the two cycles. Following cycle 1, significant improvements were noted, with 100% correct responses for how to request a pertussis test, appropriate timing for ordering the tests, and the incubation period. Both cycles demonstrated improvement as all participants knew the first-line antibiotic treatment for pertussis. What does it mean? Although our sample size was small, our project showed that the overall knowledge of our clinicians improved in the 2 cycles. Ongoing education is needed to improve awareness of pertussis infection, especially during the winter months.

DOI: 10.1136/archdischild-2025-rcpch.413

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Magnet ingestion in children in the United Kingdom: a national prospective observational surveillance study (2025)

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Type of publication:

Journal article

Author(s):

Neville J.J.; Lyttle M.D.; Messahel S.; Parkar S.; Mytton J.; Hall N.J.; Brooker H.; Varnam R.; Putt-Willis D.; Smith M.; Smith L.; Yusuf I.; Dean N.; Patel D.; Rahman M.; Vooght E.; Parveen R.; Shirley-Mansell L.; Cresner R.; Cromarty T.; Broomfield R.; Bayreuther J.; Bethell G.; Major C.; Barling J.; Wilson V.; Maney J.; Wilson K.; Ratnaraj D.; Divakaran D.; Hickey J.; Ranasinghe D.; Foster A.; Martin B.; Walker R.; Jones C.; Soans E.; Monk A.; Rahman A.; Tambudze K.; Hopgood D.; Downes A.; Nasreen T.; Preskey S.; Long J.; Adamson J.; Henderson R.; Andreassen H.; Chadwick H.L.; Towart G.; Abdelhafiz K.; O'Connor E.; Carlyle D.; Tubman L.; Wallace K.; Mohamed A.; Siner S.; Fissler S.; Mcleish S.; Tolhurst-Cleaver M.; Fletcher S.; Russell M.; Winrow K.; Taylor J.; Armitage A.; Geoghegan K.; Buckle R.; Wood S.; Tremarco L.; Collins V.; Egginton D.; Simpson G.; Dowsett S.; Djendow F.; Jarman H.; Edyta K.; Dotchin M.; Potter S.; Kamaraj K.; Fagelnor A.; Dadnam C.; Shafiq A.; Lewis S.; Zarifa I.; Craigie R.; Aldridge P.; Veeraragavan N.; Haslam Z.; Carney A.; Rimmer G.; Jones S.; Richardson S.; Riddick L.; McCourt E.; Azad-Karim A.; Quigley K.; Yassin S.; Merrick V.; Salter R.; Yoshida R.; Bass J.; Vincent E.; Healy C.; Jones E.; Ball E.; Azam A.; Ryan E.; Bedoya S.; Keers S.; Blaney E.; Peacock P.; Hartshorn S.; Cash V.; Snelson E.; Coles V.; Stacey A.; Zuhairy S.; Chandler L.; Pinedo J.; Bradley A.; Gate V.; *Sanlon N.; *Juttiga U.; *Marsh A.; *Okeke C.; *Ali N.; Ramlakhan S.; Subramanian T.; Haffenden V.; Obire J.; Hartin D.; Darlow N.; Beeby D.; Francis R.; Basu S.; Saxena A.; Jeropoulos R.; Hegan A.; Browning J.; Craven E.; Foster S.;

Citation:

Archives of Disease in Childhood. (no pagination), 2025 Sep 18;110(10):778-785.

Abstract:

Objective: Magnet ingestion in children and young people (CYP) is associated with significant harm. We aimed to describe the incidence, circumstances and outcomes of magnet ingestion in CYP in the United Kingdom (UK). Design(s): Prospective multicentre observational surveillance study. <br/>Setting(s): UK secondary and tertiary level hospitals in urban and rural settings. Patient(s): CYP <=16 years of age who ingested >=1 magnet. Intervention(s): Data were collected regarding demographics, circumstances surrounding ingestion, clinical features and management. The primary outcome was the incidence of magnet ingestion in the UK. Result(s): Between 1 May 2022 and 30 April 2023, 366 cases of magnet ingestion were recorded, of which 314 met eligibility (median age 8.7 years (IQR 5.1-12.0)). The incidence of magnet ingestion in the UK was at least 2.4/100 000 (95% CI 2.2 to 2.7) CYP per year. CYP sourced magnets from toys (38%), and magnet products were predominantly purchased by parents or caregivers (19%). Magnet-related injuries occurred in 23 (7%) cases, and surgery was undertaken in 32 (10%). Single magnet ingestions did not cause magnet-related injury. Swallowing greater numbers of magnets associated with an increased risk of injury (OR 1.1 (95% CI 1.0 to 1.2), p=0.002). CYP were asymptomatic in 75% of cases, but clinical features on presentation were associated with an increased risk of injury (OR 3.8 (95% CI 1.4 to 10.3), p=0.008). Conclusion(s): While magnet ingestion in children is uncommon, ingestion of multiple magnets can cause injuries requiring surgery. Greater public and clinician awareness of the associated risks is warranted. This study can inform public health interventions and evidence-based guidelines.

DOI: 10.1136/archdischild-2024-328195

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Glycerol intoxication syndrome in young children, following the consumption of slush ice drinks (2025)

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Type of publication:

Journal article

Author(s):

Brothwell, Shona Lc; Fitzsimons, Patricia E; Gerrard, Adam; Schwahn, Bernd C; Stockdale, Christopher; Bowron, Ann; Anderson, Mark; Hart, Claire E; Hannah, Romanie; Ritchie, Francesca; *Deshpande, Sanjeev A; Sreekantam, Srividya; Watts, Gemma; Yap, Sufin; Mundy, Helen; Veiraiah, Aravindan; Collins, Abigail; Cozens, Alison; Morris, Andrew A; Crushell, Ellen.

Citation:

Archives of Disease in Childhood. 2025 Jul 18;110(8):592-596

Abstract:

INTRODUCTION: Slush ice drinks are commonly available refreshments, aimed at children and young people. Glycerol is used to maintain the slush effect in the absence of a high sugar content.

OBJECTIVE: To describe a series of children who became acutely unwell shortly after consuming a slush ice drink; their presentation mimics specific inherited metabolic diseases (IMDs).

METHODS: A retrospective case review of 21 children who presented to centres across the UK and Ireland from 2009 through 2024 was carried out.

RESULTS: Almost all of the children (93%) became unwell within 60 min of slush ice drink consumption. None had any relevant past medical history. The median age at presentation was 3 years 6 months (range 2 years – 6 years 9 months). Presenting features include acute decrease in consciousness (94%), hypoglycaemia (95%), metabolic (lactic) acidosis (94%), pseudohypertriglyceridaemia (89%) and hypokalaemia (75%). Glyceroluria was present in all acute urine organic acid samples. No underlying IMD was found in the 14 patients who underwent further enzymatic or genetic testing. The majority (95%) subsequently avoided slush ice drinks and did not have reoccurrence.

CONCLUSION: Consumption of slush ice drinks containing glycerol may cause a clinical syndrome of glycerol intoxication in young children, characterised by decreased consciousness, hypoglycaemia, lactic acidosis, pseudohypertriglyceridaemia and hypokalaemia. This mimics inherited disorders of gluconeogenesis and glycerol metabolism. Clinicians and parents should be alert to the phenomenon, and public health bodies should ensure clear messaging regarding the fact that younger children,
especially those under 8 years of age, should avoid slush ice drinks containing glycerol.

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