Question: Melatonin for ADHD?

Does melatonin improve sleep pattern in children with Attention Deficit Hyperactivity Disorder? Adam is an 8 year old boy with Attention Deficit Hyperactivity Disorder (ADHD) who you see with his mother in your paediatric outpatient clinic. She explains that life is being made increasingly stressful for the whole family as Adam is having difficulty getting […]

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Question: ECMO – any benefit for neonates?

Does extra-corporeal membrane oxygenation improve survival for severely unwell neonates with Congenital Diaphragmatic Hernia? A neonate on the intensive care unit with an isolated congenital diaphragmatic hernia is failing on conventional ventilation. There are no exclusion criteria for extra-corporeal membrane oxygenation (ECMO). Should the neonate be transferred for ECMO? […]

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Question: How to diagnose and treat pyelonephritis

In children suspected of having a UTI, what clinical and radiological features diagnoses pylonephritis, and what mode of antibiotic treatment is necessary to produce clinical improvement and avoid chronic renal impairment? With the publication of the NICE guidance in the UK on the management of UTI in childhood, many paediatricians have been spurred to review […]

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Are there effective strategies to reduce the length of stay for “well” near-term babies?

Length of stay for ‘well’ near term (30-36 week gestation) babies varies between units and between countries, with the UK average being discharge at 36+2 weeks corrected. What strategies are in place in your unit to help these ‘small but well’ babies get out of precious neonatal cots into their own lovingly decorated cribs at […]

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GnRH analogues to prevent ovarian failure?

Should gonadotropin releasing hormone analogue be administered to prevent premature ovarian failure in young women with systemic lupus erythematosus on cyclophosphamide therapy? A 15 year old girl with acute renal failure was found to have class IV systemic lupus erythematosus (SLE) nephritis on renal biopsy. A decision was taken to start her on the routine […]

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Question: Insulin for hyperglycaemic PICU patients?

Should paediatric critically ill patients receive insulin therapy to maintain strict normoglycaemia? Joseph, a 4 year old boy with septic shock, lactic acidosis and multi-organ failure has been admitted to the paediatric intensive care unit. Mechanical ventilation, vaso-active support, and renal replacement therapy (CVVHD) are initiated. His serum glucose level is 10.5 mmol/l. The senior […]

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