You are called to the postnatal ward to review a 22-hour-old infant with feeding difficulties. On examination, two bluish, soft swellings are located medially to the inner canthus on both eyes. The infant is unsettled but has a mild fever. What do you do? What is dacryocystitis? Dacryocystitis is an inflammation of the lacrimal sac. This oval-shaped structure receives tear drainage from the eye and sits in a groove formed by the lacrimal bone and frontal process of the maxilla. The lacrimal sac is not the same as the lacrimal gland. This exocrine gland produces tears and is located within ..read more

When does respiratory failure become PARDS, and how should we manage it? Peter, a 2-month-old boy, is admitted to the paediatric ward on high-flow nasal oxygen with presumed bronchiolitis. Over the day, his oxygen requirement dramatically increased to the point of requiring intubation.  He is transferred to the regional PICU, where ventilation becomes increasingly challenging, with high airway pressures and poor oxygenation. You spend a challenging night responding to ventilator alarms and dramatic desaturations. During the morning handover, the PICU consultant suspects PARDS, and you ..read more

Conservative versus liberal oxygenation targets in PICU Every year in the UK, about 14,000 children needing intubation and ventilation are taken care of in children’s intensive care units, and they often receive supplemental oxygen as part of their treatment. Despite this, data regarding optimum SpO2 targets within PICU are scarce.  Recent studies, in both adults and children, highlight the potential harms of exposure to a high fraction of inspired oxygen (FiO2). In 2017, however, a retrospective analysis found that more than a quarter (26%) of saturation recordings were in the 99-100% r ..read more

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly Paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital).  This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research. In this month’s list of the journal club, we would like to draw your attention to some studies that ..read more

Your paediatrics clinical rotation is dawning upon you. For some of you, this may be the start of the happiest 1-2 months of your medical degree. For others, it may seem like just another placement to get through. For some, however, this rotation may seem daunting. Though an interest in paediatric medicine goes a long way towards shaping an enjoyable and fruitful paediatric rotation, there are several aspects of this rotation which set it apart from other specialities.  Paediatrics is not all about parenting children and surviving their tantrums. Medicine is intertwined with comfort, care ..read more

There has been a notable shift in paediatric admissions in Ireland. This has coincided with a widespread shortage of specialist placements for children facing behavioural, psychiatric, and child protection challenges, leading to an over-reliance on the placement of these children in hospitals. Whilst paediatric social admissions (PSA) are not a novel concept, they have gained increased attention and significance in recent years. A paediatric social admission is one where a child is admitted to the hospital but not for a medical reason. They often have complex care needs secondary to their m ..read more

4-year-old Stephanie presents with vomiting, diarrhoea, and lethargy. She appears pale and dehydrated, and her level of alertness fluctuates. She is apyrexial, tachycardic and normotensive. She receives fluid resuscitation, and you organise some tests to find out why she is so tired. Her urine dip is positive for erythrocytes, protein, and leukocytes and negative for nitrates. What causes haematuria in children? Haematuria in children is common. Most cases are microscopic (i.e. only detected on urinalysis rather than visible with the naked eye) and asymptomatic. Some red flags to watch ..read more

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly Paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital).  This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research. This month’s list includes many interesting studies, but as always, we have highlighted a few. In ..read more

With millions of journal articles published yearly, it is impossible to keep up.  Our team have scoured the literature, so you don’t have to… or it might spark an interest to go and have a look at the full article. We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s a great idea and maybe something for other centres to copy!) The Bristol Royal Hospital for Children (BRHC) is a tertiary paediatric hospital that provides a local service for Bristol children and a referral service for speci ..read more

Non-invasive BiPAP can be a successful ventilation strategy for status asthmaticus, removing the need for intubation and the complications associated with this. A 6-year-old known asthmatic presents to ED with a two-day history of cough and coryza, worsening wheeze and work of breathing over the last day. He is usually managed with beclomethasone twice daily and salbutamol as needed. On arrival, he had an oxygen saturation of 88% in air and significantly increased work of breathing. His respiratory rate was 36 breaths per minute, and his heart rate was 144.  He was started on nasal c ..read more