eLetters

1433 e-Letters

  • The sensitivity of non-invasive clinical examination to detect dehydration has been questioned without any evidence
    Malcolm G Coulthard

    The ADC Archivist recently reported that Freedman et al had revealed that "old-fashioned clinical examination" missed about 20% of cases of significant dehydration in children.[1] Their assessment of this work was not surprising because the meta-analysis in the Journal of Pediatrics carries the headline message that even the "most accurate, noninvasive" methods could only "identify dehydration suboptimally", and it was a...

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  • Imaging in suspected child abuse
    Peter D Sidebotham

    Monika Bajaj and Amaka Offiah are to be commended for their thoughtful and helpful review of the benefits and risks of skeletal imaging in cases of suspected child abuse.(1) The diagnosis of child abuse is a complex process which requires an evidence-informed approach combining clinical acumen with collaborative multi-agency working. Skeletal imaging, including CT scans, provide a valuable tool for the clinician, but,...

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  • Herpes Zoster possibly unreported in childhood
    Justin Daniels

    This editorial is a very helpful review of the current state of the debate.

    I am concerned that zoster is under diagnosed in childhood because of lack of familiarity in both primary and secondary care. Anecdotally it is not uncommon in a paediatric unit, in otherwise well children, but does cause significant concern and use of resources. This needs to be accurately captured as it may shift the economic modelling...

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  • Treatment of the hyperinsulinaemic hypoglycaemia unresponsive to diazoxide and octreotide: sirolimus should be considered
    Federico Marchetti

    Dear Editor

    In their excellent review on the hypoglycaemia in childhood the authors suggest that for the management of the hyperinsulinaemic hypoglycaemia (HH) diazoxide is the first-line therapy (1). Patients who do not respond to diazoxide may respond to the octreotide but the efficacy of this is often limited by tachyphylaxis. Mutations in ABCC8 and KCNJ11 are associated with severe HH that is unresponsive to...

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  • Re: Faecal calprotectin as an effective diagnostic aid for necrotising enterocolitis
    James Frederick Bremner Houston

    Many thanks for the recent letter regarding a rapid assay technique for testing fecal calprotectin1. This would indeed be useful in the clinical setting if it allows the transmission of accurate and rapid fecal calprotectin levels to treating clinicians. As discussed in the original archimedes report, the difficulties surrounding the need for an adequate cut-off remain the main barrier to the use of fecal calprotectin a...

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  • Re: Where do the differences in childhood mortality rates between England & Wales and Sweden originate?
    Ingrid Wolfe

    We thank Zylbersztejn, et al for their constructive letter and for their support for the Countdown initiative. Their data suggests that high rates of preterm birth and thresholds for reporting preterm birth [1] in the UK were one of the most likely explanations for the disparities seen between the UK and European countries such as Sweden, and we agree this is likely (as outlined in our recent Lancet paper [2]. We agree en...

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  • Re: Pickled Red Herrings
    Ingrid Wolfe

    Colvin correctly notes that we are interested in solution-focused research, and expresses some anxiety about our recommendations for improving child survival. There are two issues to consider in addressing his concerns: determining causality, and the burden of proof required to take action.

    First, Bradford Hill's criteria for considering causality are helpful in demonstrating why the association between poverty...

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  • Re: Tachypnoea in a well baby: don't forget the head
    Ian M Balfour-Lynn

    Dear Editor

    We are so sorry not to have included cerebral arterio-venous fistula in the aetiology of unexplained tachypnoea because it is of course a rare but classic cause. Typically the symptoms begin almost immediately after birth if there is a large fistula and the pulmonary artery pressure remains elevated. The fistula allows a large systemic artery to systemic venous shunt with right atrial and right vent...

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  • Re: A useful tool for parents
    Lane E Volpe

    We would like to thank Dr Levene for her letter, and the Editors for the opportunity to respond. The authors are familiar with the Infant Sleeplab App; we are both associated with the Durham University Parent- Infant Sleep Lab (Dr Volpe as an Honorary Fellow, and Professor Ball as the Founder and Director). The Infant Sleep Info Source Website (ISIS, www.isisonlineorg.uk) was conceived of in 2010 by Professor Ball and her...

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  • Re:The Skeletal Survey in suspected abuse- how necessary is it?
    Amaka C Offiah

    We thank Dr Cohn and his colleagues for their interest in our article and agree - as stated within our paper - that there is considerable variability in the reported fracture yield of skeletal surveys. This variability is not only dependent on methods of data display (as Dr Cohn et al illustrate), but also on epidemiological and demographic differences between reported study populations and on the process by which clinicia...

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