Dear editor, we read with interest the randomised controlled trial by Borgström et al.1 showing the lack of effectiveness of daytime urotherapy as first-line treatment of nocturnal enuresis. While the study has the remarkable point of strength of a prospective trial with a control, we take exception with some of the authors’ statements, and believe that some limits should be acknowledged.
Reduction of enuresis frequency was evaluated after 7 and 8 weeks since the beginning of the study while previous studies showed effectiveness for longer treatments, lasting four months, with a 60% success rate2. While the authors acknowledge this difference they simply state that a longer duration would disqualify the therapy as a first-line choice anyway, increasing the risks of drop out. We believe that this is, as the author state in the discussion, simply their view, which is not based on any evidence. The length of a treatment should not necessarily rule out it as a first line option, especially when weighted against the costs of other options, specifically unpleasantness of the alarm and possible adverse effects of desmopressin. As a matter of fact, it could be speculated that 8 weeks are a too short period in a physiological perspective to develop different voiding patterns after years of an enuretic bladder function.
Moreover, patients’ follow-up consisted only in contact by phone after 2 and 6 weeks, without clinical examination, and this could have contributed t...
Dear editor, we read with interest the randomised controlled trial by Borgström et al.1 showing the lack of effectiveness of daytime urotherapy as first-line treatment of nocturnal enuresis. While the study has the remarkable point of strength of a prospective trial with a control, we take exception with some of the authors’ statements, and believe that some limits should be acknowledged.
Reduction of enuresis frequency was evaluated after 7 and 8 weeks since the beginning of the study while previous studies showed effectiveness for longer treatments, lasting four months, with a 60% success rate2. While the authors acknowledge this difference they simply state that a longer duration would disqualify the therapy as a first-line choice anyway, increasing the risks of drop out. We believe that this is, as the author state in the discussion, simply their view, which is not based on any evidence. The length of a treatment should not necessarily rule out it as a first line option, especially when weighted against the costs of other options, specifically unpleasantness of the alarm and possible adverse effects of desmopressin. As a matter of fact, it could be speculated that 8 weeks are a too short period in a physiological perspective to develop different voiding patterns after years of an enuretic bladder function.
Moreover, patients’ follow-up consisted only in contact by phone after 2 and 6 weeks, without clinical examination, and this could have contributed to poor effectiveness of urotherapy too.
Lastly and above all, the authors considered daytime incontinence and voiding dysfunction among the exclusion criteria of the study, but it is well known that many enuretic children present daytime symptoms too in up to 90% of cases2 or bladder dysfunction even with enuresis as the only detectable symptom.3 These disorders, once identified, must be treated because they can lead to urological dysfunctions in adulthood4 and behavioural therapy still represents a cornerstone of treatment. We believe that this is a further reason why urotherapy should not be disqualified as a first-line treatment only without the evidence of long term treatment data.
In conclusion, we suggest that daytime urotherapy studies need to be carried out for longer periods to confirm or rule out its effectiveness. Until then urotherapy should not be considered an alternative choice to alarm therapy and pharmacological treatment but a complementary one, in order to obtain a global approach to nocturnal enuresis in children.
Bibliography
1. Borgström M, Bergsten A, Tunebjer M, et al. Daytime urotherapy in nocturnal enuresis: a randomised, controlled trial. Archives of Disease in Childhood Published Online First: 24 January 2022. doi: 10.1136/archdischild-2021-323488
2. Pennesi M, Pitter M, Bordugo A, Minisini S, Peratoner L. Behavioral therapy for primary nocturnal enuresis. J Urol. 2004; 171(January):408-410. doi:10.1097/01.ju.0000097497.75022.e8
3. Yeung CK, Chiu HN, Sit FKY. Bladder dysfunction in children with refractory monosymptomatic primary nocturnal enuresis. J Urol. 1999; 162:1049-1055.
4. Bower WF, Sit FKY, Yeung CK. Nocturnal Enuresis in Adolescents and Adults is Associated With Childhood Elimination Symptoms. J Urol. 2006; 176(October):1771-1775. doi:10.1016/j.juro.2006.04.087
By excluding all deaths, it is possible that a significant number of high-cost high-need patients were missed? Some deaths will follow a prolonged admission and care may have been escalated, for example to PICU, prior to death.
This review1, listing all the pros and cons of covid vaccinations for children, is to be welcomed but the authors have omitted some important questions on the downside. They rightly state that a large proportion of children might already be immune and point to waning immunity after vaccinations, suggesting that primary infection at young age with boosting exposure over time might be a better strategy. But they do not cite recent evidence that people who are first vaccinated then exposed afterwards, appear to mount brisk IgG response to the spike protein since this is already in their immune memory, but may fail to mount the broader response associated with natural infection, including N-antibodies2. For those children (>75%) already immune, there is no significant benefit to vaccination with an emergency use authorised product. For otherwise healthy children who are not yet immune, they can obtain this by natural infection over the months ahead, at minimal risk to themselves or to the vaccinated adults around them.
Under the heading ‘Long-term safety’, the authors rightly quote concerns of possible ongoing effects of myocarditis, but they make no mention of any other potential as yet unknown effects of these novel technologies. If there are effects on T-cell function, then there is risk for autoimmune diseases3 and also for potential cancer cells4 to pass unchecked. There are also no adequate animal reproductive studies and the nanoparticles have been shown b...
This review1, listing all the pros and cons of covid vaccinations for children, is to be welcomed but the authors have omitted some important questions on the downside. They rightly state that a large proportion of children might already be immune and point to waning immunity after vaccinations, suggesting that primary infection at young age with boosting exposure over time might be a better strategy. But they do not cite recent evidence that people who are first vaccinated then exposed afterwards, appear to mount brisk IgG response to the spike protein since this is already in their immune memory, but may fail to mount the broader response associated with natural infection, including N-antibodies2. For those children (>75%) already immune, there is no significant benefit to vaccination with an emergency use authorised product. For otherwise healthy children who are not yet immune, they can obtain this by natural infection over the months ahead, at minimal risk to themselves or to the vaccinated adults around them.
Under the heading ‘Long-term safety’, the authors rightly quote concerns of possible ongoing effects of myocarditis, but they make no mention of any other potential as yet unknown effects of these novel technologies. If there are effects on T-cell function, then there is risk for autoimmune diseases3 and also for potential cancer cells4 to pass unchecked. There are also no adequate animal reproductive studies and the nanoparticles have been shown by Pfizer to concentrate in the ovaries and testes5 in rats. These more theoretical risks may be of less concern to adults, particularly those a relatively high risk from covid. But for children, with their whole lives ahead of them, we absolutely must remember the maxim, ‘First do no harm’.
Most importantly, the authors state that, ‘Subjecting children to potential risk of vaccine adverse effects to drive indirect effects with little or no direct benefit might be ethically questionable’. I would contest that is unethical to ask children to take a vaccine to boost herd immunity or to offset political decisions such as school closures, at a stage when the drug trials have still to be completed. Policy makers would do well to re-read the Universal Declaration on Bioethics and Human Rights6 and to follow the authors’ guidance to ‘weigh up the risks and benefits with caution and to proceed with care’.
1. Zimmermann P, Pittet LF, Finn A, et al. Should children be vaccinated against COVID-19? Archives of Disease in Childhood Published Online First: 03 November 2021. https://doi.org/10.1136/archdischild-2021-323040
2. UK Health Security Agency. COVID-19 vaccine surveillance report Week 44 https://assets.publishing.service.gov.uk/government/uploads/system/uploa...
3. Ishay Y, Kenig A, Tsemach-Toren T, et al. Autoimmune phenomena following SARS-CoV-2 vaccination. Int Immunopharmacol. 2021;99:107970. https://doi.org/10.1016/j.intimp.2021.107970
4. Jiang, H, Mei, Y-F. SARS–CoV–2 Spike Impairs DNA Damage Repair and Inhibits V(D)J Recombination In Vitro. Viruses 2021, 13, 2056. https://doi.org/10.3390/v13102056
5. Pfizer biodistribution data. https://www.naturalnews.com/files/Pfizer-bio-distribution-confidential-d...
6. Universal Declaration on Bioethics and Human Rights (2005). http://portal.unesco.org/en/ev.php-URL_ID=31058&URL_DO=DO_TOPIC&URL_SECT...
The Centers for Disease Control and Prevention (CDC) now recommends a Covid -19 vaccine for children ages 5 and older. Johns Hopkins Medicine encourages all families to have eligible children vaccinated with the Covid - 19 vaccine. Currently, Pfizer's vaccine is the only approved Covid-19 vaccine for children and its side effects are still the same in children. Children might notice pain at the injection site (upper arm), and could feel more tired than usual. Headache, achy muscles or joints, and even fever and chills are also possible and these side effects are usually temporary and generally clear up with 48 hours.
Child mortality in Europe dropped considerably in the first year of the pandemic, but since mid-2021 it is increasing considerably, as the data from the euromomo registry suggest. https://www.euromomo.eu/graphs-and-maps/ I first thought that Corona "saves children´s life" (for an intolerable expense), but now the contrary is true. While by the end of 2020 almost 400 Children (0-14) less died in the participating countries, excess mortality in Europa was about 500 Children at the end of 2021. So it was to early to draw conclusions.
We read with great interest recent study by Vergnano et al.1 investigating the epidemiology, age at infection, clinical characteristics, and outcome of listeria infection in the young infant. We congratulate the authors on providing a novel and interesting study that is relevant to the UK population and agree that the empirical use of amoxicillin in the paediatric infant should be reconsidered given the conclusions of their data.
However, when considering how we might be able to incorporate your novel findings into our centres practice, we required further clarification on table 2. The table describes increased oxygen requirement/respiratory support in 2/27 infants and yet, within results, report a prevalence of increased oxygen requirement/respiratory support of 89%. Furthermore, hypotension requiring inotropes is reported to occur in 4/27 infants but has a reported prevalence of 115%. These reported data appear to be miscalculated.
Clinical identification of invasive listeriosis through the understanding of symptoms within the infant is a key finding of this study given its poor description within the current literature2. We conducted a focused literature search and found scarce information on infant symptom prevalence; one notable exception includes the MONALISA study by Charlier et al.3 which recorded detailed clinical features (appendix p 21). Early diagnosis of invasive listeriosis has been demonstrated to have key prognostic value...
We read with great interest recent study by Vergnano et al.1 investigating the epidemiology, age at infection, clinical characteristics, and outcome of listeria infection in the young infant. We congratulate the authors on providing a novel and interesting study that is relevant to the UK population and agree that the empirical use of amoxicillin in the paediatric infant should be reconsidered given the conclusions of their data.
However, when considering how we might be able to incorporate your novel findings into our centres practice, we required further clarification on table 2. The table describes increased oxygen requirement/respiratory support in 2/27 infants and yet, within results, report a prevalence of increased oxygen requirement/respiratory support of 89%. Furthermore, hypotension requiring inotropes is reported to occur in 4/27 infants but has a reported prevalence of 115%. These reported data appear to be miscalculated.
Clinical identification of invasive listeriosis through the understanding of symptoms within the infant is a key finding of this study given its poor description within the current literature2. We conducted a focused literature search and found scarce information on infant symptom prevalence; one notable exception includes the MONALISA study by Charlier et al.3 which recorded detailed clinical features (appendix p 21). Early diagnosis of invasive listeriosis has been demonstrated to have key prognostic value in the literature4. Consequently, we submit that clearly described clinical presentations, and an understanding of their respective prevalence, could reduce the high mortality associated with invasive listeriosis3 and improve patient outcomes in the future.
Given the relative lack of understanding and the debate within the literature relating to the symptomatic presentation and clinical picture of listeria infection in the infant, especially in a UK population, your article has the potential to clarify clinical signs of useful predictive value. We would be very grateful for clarification on this matter to incorporate into our own practice.
References
1. Vergnano S, Godbole G, Simbo A, et al. Listeria infection in young infants: results from a national surveillance study in the UK and Ireland. Archives of Disease in Childhood 2021;106(12):1207-10. doi: 10.1136/archdischild-2021-321602
2. de Noordhout CM, Devleesschauwer B, Angulo FJ, et al. The global burden of listeriosis: a systematic review and meta-analysis. The Lancet Infectious Diseases 2014;14(11):1073-82. doi: https://doi.org/10.1016/S1473-3099(14)70870-9
3. Charlier C, Perrodeau É, Leclercq A, et al. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. The Lancet Infectious Diseases 2017;17(5):510-19. doi: https://doi.org/10.1016/S1473-3099(16)30521-7
4. Hof H. An update on the medical management of listeriosis. Expert Opinion on Pharmacotherapy 2004;5(8):1727-35. doi: 10.1517/14656566.5.8.1727
re Diagnosing urinary tract infection in children: time to ditch the pad?
Harkensee C, Clennett J, Wilkinson S, et al
Arch Dis Child 2021; 106: 935-936
We read with interest the article by Harkensee et al, (1) suggesting that the urinary collection pad (UCP) no longer had a role in obtaining samples for diagnosis of urinary tract infections (UTI). Whilst it is well established that there is an unacceptably high rate of contamination with UCPs making them unsuitable for microbiological culture, and that the preferred (non-invasive) method for obtaining a sample for culture is by 'clean catch' +/- stimulation or Quick-Wee method, we would suggest that the UCP has a role in screening for UTI, by dipstick analysis of the aspirated pad sample for leucocyte esterase (LE) and nitrites (2). It would be useful, in a paediatric 'acute referral clinic' or Emergency Department, in infants or children, with non-specific abdominal pain, or fever without a focus, where a combination of a negative test for both LE and nitrites can be reasonably used to exclude UTI, and equally a positive LE and nitrite result would indicate a high likelihood of a UTI and the need to obtain a 'clean catch' or catheter specimen for microbiological analysis (3). The advantages of the UCP are that it allows 'point of care' dipstick analysis with inf...
re Diagnosing urinary tract infection in children: time to ditch the pad?
Harkensee C, Clennett J, Wilkinson S, et al
Arch Dis Child 2021; 106: 935-936
We read with interest the article by Harkensee et al, (1) suggesting that the urinary collection pad (UCP) no longer had a role in obtaining samples for diagnosis of urinary tract infections (UTI). Whilst it is well established that there is an unacceptably high rate of contamination with UCPs making them unsuitable for microbiological culture, and that the preferred (non-invasive) method for obtaining a sample for culture is by 'clean catch' +/- stimulation or Quick-Wee method, we would suggest that the UCP has a role in screening for UTI, by dipstick analysis of the aspirated pad sample for leucocyte esterase (LE) and nitrites (2). It would be useful, in a paediatric 'acute referral clinic' or Emergency Department, in infants or children, with non-specific abdominal pain, or fever without a focus, where a combination of a negative test for both LE and nitrites can be reasonably used to exclude UTI, and equally a positive LE and nitrite result would indicate a high likelihood of a UTI and the need to obtain a 'clean catch' or catheter specimen for microbiological analysis (3). The advantages of the UCP are that it allows 'point of care' dipstick analysis with information to guide clinical decision-making immediately, is passive with minimal parental effort and disruption to the child, there is less likelihood of missing a sample (compared with 'clean catch') and is the preferred collection method of parents.
Perhaps, it's not time to ditch the pad: pads have a place!
Mervyn S Jaswon
James Diviney
Dept of Paediatrics, Whittington Hospital, London1.Diagnosing urinary tract infection in children: time to ditch the pad?
1.Diagnosing urinary tract infection in children: time to ditch the pad?
Clennett J, Wilkinson S, et al Arch Dis Child 2021; 106: 935-936
2. Urine collection methods and dipstick testing in non-toilet-trained children.
Diviney J, Jaswon M S, Pediatric Nephrology 2021; 36; 1697-1708
3. Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of UTI in children: a systematic review and economic model.
Whiting P, Westwood M, et al HEalth Technol Assess 10:iii-iv, xi-xiii" "
We read with interest the paper by Baines and Colleagues [1] in which
the authors reported a strong inverse relationship between total serum
calcium concentrations and disease severity in 70 critically ill children
with meningococcal disease. Calcitonin concentrations were measured in a
subgroup of 23 children on admission, and significantly correlated with
disease severity. In particular, however, the...
We read with interest the paper by Baines and Colleagues [1] in which
the authors reported a strong inverse relationship between total serum
calcium concentrations and disease severity in 70 critically ill children
with meningococcal disease. Calcitonin concentrations were measured in a
subgroup of 23 children on admission, and significantly correlated with
disease severity. In particular, however, the authors found no relation
between calcitonin concentrations and total or ionised calcium
concentrations.
In a study of 69 adult patients with acute pancreatitis,[2] we have
similarly found no correlation between plasma concentrations of calcitonin
precursors (CTpr) on admission[2] and both the admission and lowest
(within 72 hours of admission) adjusted total serum calcium concentrations
(data unpublished before). The concentrations of CTpr were significantly
higher[2] and of the lowest calcium were significantly lower [median
(IQR): 2.16 (2.0-2.18) mmol/l vs. 2.23 (2.15-2.30) mmol/l, p=0.017] in
patients with severe attacks (n=14, Atlanta criteria) compared with mild
attacks.
Our data and that of Baines and colleagues[1] support the contention that
calcitonin and its precursors have a minor effect on calcium metabolism.
Indeed, previous investigators found no correlation between the serum
concentrations of serum calcitonin and hypocalcaemia in patients with
acute pancreatitis[3,4] or in experimental models of the disease.[5]
Whilst CTpr concentrations were reported to rise significantly in
critically ill patients, they correlated rather weakly with a concomitant
fall in serum ionised calcium.[6] A rise in CTpr concentrations did not
correlate with the fall in serum calcium concentrations in patients with
acute malaria.[7] This suggests that factors other than calcitonin and
CTpr are involved in the homeostasis of calcium in the critically ill.
References
(1) Baines PB, Thomson AP, Fraser WD, Hart CA. Hypocalcaemia in severe meningococcal infections. Arch Dis Child 2000;83:510-3.
(2) BJ Ammori, KL Becker, P Kite, et al. Calcitonin precursors in the prediction of severity of acute pancreatitis on the day of admission. Br J
Surg (in press).
(3) Robertson GM Jr, Moore EW, Switz DM, Sizemore GW, Estep HL. Inadequate parathyroid response in acute pancreatitis. N Engl J Med 1976;294:512-6.
(4) Gillquist J, Larsson J, Sjodahl R. Serum calcitonin in acute
pancreatitis in man. Scand J Gastroenterol 1977;12:21-5.
(5) Izquierdo R, Bermes E Jr, Sandberg L, Saxe A, Oslapas R, Prinz RA.
Serum calcium metabolism in acute experimental pancreatitis. Surgery 1985;98:1031-7.
(6) Muller B, Becker KL, Kranzlin M, et al. Disordered calcium homeostasis
of sepsis: association with calcitonin precursors. Eur J Clin Invest
2000;30:823-31.
(7) Davis TM, Assicot M, Bohuon C, St John A, Li GQ, Anh TK. Serum
procalcitonin concentrations in acute malaria. Trans R Soc Trop Med Hyg
1994;88:670-1.
Thank you authors, for recommending valuable guidelines for
disclosure of diagnosis. I believe they are really useful however I do
feel presence of infants at the time of disclosure of the diagnosis is
good practice but I would like to suggest caution because most of the
times then, the parents are distracted by them and pay most of their
attention in caring for them and making sure they are comfortable. I feel
this mak...
Thank you authors, for recommending valuable guidelines for
disclosure of diagnosis. I believe they are really useful however I do
feel presence of infants at the time of disclosure of the diagnosis is
good practice but I would like to suggest caution because most of the
times then, the parents are distracted by them and pay most of their
attention in caring for them and making sure they are comfortable. I feel
this makes the parents less likely to take in all the information
delivered by the clinician and at times the interview could also be
interrupted by infants at a critical juncture.
I am also not sure about the effects of breaking bad news infront of
the babies if they see their parents distressed or tearful, as could be
the case or how much they could understand whats going on?
Further, I would also like to suggest that any junior doctors who may
not have a clear role in future management but who had a significant role
in the previous management of the infant could be allowed to be present at
the time of disclosure as it may well be the case that parents are
familiar with the junior doctor more than the consultant and this would
also be a useful training experience for the junior doctors.
The paper by Cappendijk and Hazebroek[1] successfully demonstrates
the problems with diagnosis of appendicitis in the young child.
It makes the important point that diarrhoea may be a feature of
appendicitis and lead to misdiagnosis. In addition, children can have
coexisting pathologies leading to delayed diagnosis. We have seen a cystic
fibrosis child with DIOS (distal intestinal obstruction...
The paper by Cappendijk and Hazebroek[1] successfully demonstrates
the problems with diagnosis of appendicitis in the young child.
It makes the important point that diarrhoea may be a feature of
appendicitis and lead to misdiagnosis. In addition, children can have
coexisting pathologies leading to delayed diagnosis. We have seen a cystic
fibrosis child with DIOS (distal intestinal obstruction syndrome) and
appendicitis. Urinary tract infection and appendicitis can also occur
together.
Children with communication problems and learning difficulties are
another high risk group for delay in diagnosis.
The differential diagnosis of appendicitis is large[2] and a child
who presented with abdominal pain and subsequently had appendectomy need
not necessarily have suffered from appendicitis. We would be interested to
know whether the histopathological results were in agreement with clinical
diagnosis.
References
1. Cappendijk VC, Hazebroek FWJ. The impact of diagnostic delay on
the course of acute appendicitis. Arch Dis Child 2000;83:64-6
2. Hutson JM, Woodward AA and Beasley SW. Jones' Clinical Paediatric
Surgery - Diagnosis and management. Blackwell Science Asia publications.
Fifth Edition. 1999;Chapter 20:page 142.
Dear editor, we read with interest the randomised controlled trial by Borgström et al.1 showing the lack of effectiveness of daytime urotherapy as first-line treatment of nocturnal enuresis. While the study has the remarkable point of strength of a prospective trial with a control, we take exception with some of the authors’ statements, and believe that some limits should be acknowledged.
Reduction of enuresis frequency was evaluated after 7 and 8 weeks since the beginning of the study while previous studies showed effectiveness for longer treatments, lasting four months, with a 60% success rate2. While the authors acknowledge this difference they simply state that a longer duration would disqualify the therapy as a first-line choice anyway, increasing the risks of drop out. We believe that this is, as the author state in the discussion, simply their view, which is not based on any evidence. The length of a treatment should not necessarily rule out it as a first line option, especially when weighted against the costs of other options, specifically unpleasantness of the alarm and possible adverse effects of desmopressin. As a matter of fact, it could be speculated that 8 weeks are a too short period in a physiological perspective to develop different voiding patterns after years of an enuretic bladder function.
Moreover, patients’ follow-up consisted only in contact by phone after 2 and 6 weeks, without clinical examination, and this could have contributed t...
Show MoreBy excluding all deaths, it is possible that a significant number of high-cost high-need patients were missed? Some deaths will follow a prolonged admission and care may have been escalated, for example to PICU, prior to death.
This review1, listing all the pros and cons of covid vaccinations for children, is to be welcomed but the authors have omitted some important questions on the downside. They rightly state that a large proportion of children might already be immune and point to waning immunity after vaccinations, suggesting that primary infection at young age with boosting exposure over time might be a better strategy. But they do not cite recent evidence that people who are first vaccinated then exposed afterwards, appear to mount brisk IgG response to the spike protein since this is already in their immune memory, but may fail to mount the broader response associated with natural infection, including N-antibodies2. For those children (>75%) already immune, there is no significant benefit to vaccination with an emergency use authorised product. For otherwise healthy children who are not yet immune, they can obtain this by natural infection over the months ahead, at minimal risk to themselves or to the vaccinated adults around them.
Show MoreUnder the heading ‘Long-term safety’, the authors rightly quote concerns of possible ongoing effects of myocarditis, but they make no mention of any other potential as yet unknown effects of these novel technologies. If there are effects on T-cell function, then there is risk for autoimmune diseases3 and also for potential cancer cells4 to pass unchecked. There are also no adequate animal reproductive studies and the nanoparticles have been shown b...
The Centers for Disease Control and Prevention (CDC) now recommends a Covid -19 vaccine for children ages 5 and older. Johns Hopkins Medicine encourages all families to have eligible children vaccinated with the Covid - 19 vaccine. Currently, Pfizer's vaccine is the only approved Covid-19 vaccine for children and its side effects are still the same in children. Children might notice pain at the injection site (upper arm), and could feel more tired than usual. Headache, achy muscles or joints, and even fever and chills are also possible and these side effects are usually temporary and generally clear up with 48 hours.
Child mortality in Europe dropped considerably in the first year of the pandemic, but since mid-2021 it is increasing considerably, as the data from the euromomo registry suggest. https://www.euromomo.eu/graphs-and-maps/ I first thought that Corona "saves children´s life" (for an intolerable expense), but now the contrary is true. While by the end of 2020 almost 400 Children (0-14) less died in the participating countries, excess mortality in Europa was about 500 Children at the end of 2021. So it was to early to draw conclusions.
Dear Editor,
We read with great interest recent study by Vergnano et al.1 investigating the epidemiology, age at infection, clinical characteristics, and outcome of listeria infection in the young infant. We congratulate the authors on providing a novel and interesting study that is relevant to the UK population and agree that the empirical use of amoxicillin in the paediatric infant should be reconsidered given the conclusions of their data.
However, when considering how we might be able to incorporate your novel findings into our centres practice, we required further clarification on table 2. The table describes increased oxygen requirement/respiratory support in 2/27 infants and yet, within results, report a prevalence of increased oxygen requirement/respiratory support of 89%. Furthermore, hypotension requiring inotropes is reported to occur in 4/27 infants but has a reported prevalence of 115%. These reported data appear to be miscalculated.
Clinical identification of invasive listeriosis through the understanding of symptoms within the infant is a key finding of this study given its poor description within the current literature2. We conducted a focused literature search and found scarce information on infant symptom prevalence; one notable exception includes the MONALISA study by Charlier et al.3 which recorded detailed clinical features (appendix p 21). Early diagnosis of invasive listeriosis has been demonstrated to have key prognostic value...
Show More26th January 2022
To the Editor
Archives of Disease in Childhood
re Diagnosing urinary tract infection in children: time to ditch the pad?
Harkensee C, Clennett J, Wilkinson S, et al
Arch Dis Child 2021; 106: 935-936
We read with interest the article by Harkensee et al, (1) suggesting that the urinary collection pad (UCP) no longer had a role in obtaining samples for diagnosis of urinary tract infections (UTI). Whilst it is well established that there is an unacceptably high rate of contamination with UCPs making them unsuitable for microbiological culture, and that the preferred (non-invasive) method for obtaining a sample for culture is by 'clean catch' +/- stimulation or Quick-Wee method, we would suggest that the UCP has a role in screening for UTI, by dipstick analysis of the aspirated pad sample for leucocyte esterase (LE) and nitrites (2). It would be useful, in a paediatric 'acute referral clinic' or Emergency Department, in infants or children, with non-specific abdominal pain, or fever without a focus, where a combination of a negative test for both LE and nitrites can be reasonably used to exclude UTI, and equally a positive LE and nitrite result would indicate a high likelihood of a UTI and the need to obtain a 'clean catch' or catheter specimen for microbiological analysis (3). The advantages of the UCP are that it allows 'point of care' dipstick analysis with inf...
Show MoreDear Editor
We read with interest the paper by Baines and Colleagues [1] in which the authors reported a strong inverse relationship between total serum calcium concentrations and disease severity in 70 critically ill children with meningococcal disease. Calcitonin concentrations were measured in a subgroup of 23 children on admission, and significantly correlated with disease severity. In particular, however, the...
Thank you authors, for recommending valuable guidelines for disclosure of diagnosis. I believe they are really useful however I do feel presence of infants at the time of disclosure of the diagnosis is good practice but I would like to suggest caution because most of the times then, the parents are distracted by them and pay most of their attention in caring for them and making sure they are comfortable. I feel this mak...
Dear Editor
The paper by Cappendijk and Hazebroek[1] successfully demonstrates the problems with diagnosis of appendicitis in the young child.
It makes the important point that diarrhoea may be a feature of appendicitis and lead to misdiagnosis. In addition, children can have coexisting pathologies leading to delayed diagnosis. We have seen a cystic fibrosis child with DIOS (distal intestinal obstruction...
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