197 e-Letters

published between 2009 and 2012

  • The TSH Threshold in Neonatal Screening for Congenital Hipothyroidism: a Variable Solution
    Jose Ramon Alonso-Fernandez


    Dear Editor:

    In their paper on the TSH threshold in neonatal screening for congenital hypothyroidism (CH), Korada et al. (1) conclude that a threshold of 6 mIU/L for DELFIA-measured TSH in samples collected between days 5 and 8 may be preferable to the 10 mIU/L recommended by the UK Newborn Screening Programme C...

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  • Children's growth: measured but rarely plotted
    Louisa Pollock

    Lek and Hughes(1) recently highlighted concerns that opportunities for growth measurement in children attending hospital are frequently missed. This has important implications for the current UK policy for growth monitoring, which encourages opportunistic measurement. It also has important implications for clinical practice –growth faltering may result from any chronic illness or may be the only marker of abuse or neglect...

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  • "Siginificant value" of CT scan in diagnosis of Hirschsprung's associated enterocolitis?
    Ronny Cheung

    In the “Images in Paediatrics” section of ADC, Sept 2009 (1), I read with interest, and some alarm, Sheth et al.’s assertion that CT scan findings were of “significant value” in establishing the diagnosis of Hirschsprung’s associated enterocolitis.

    As the authors themselves point out, diagnosis of enterocolitis in a child with a history of endorectal pull-through operation for Hirschsprung’s disease should be m...

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  • Paediatric training for GP's
    Rajashree Ravindran

    I read with interest the article ‘making choices: why parents present to the emergency department for non-urgent care’ published in ADC journal in the October 2009 edition. Amongst the reasons mentioned for coming to PED, a total of 26 parents (18%) responded that they were either unhappy or wanted a second opinion for their child’s condition. It is this group of patients who increase the workload of staff and waiting time...

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  • Re: Bulging fontanelle in febrile infants: lumbar puncture is mandatory
    Shira Shacham

    Dear Editor, We thank doctors Beri and Hussain for their comments. They disagree with the suggestion of withholding a lumbar puncture in a specific subset of infants with fever and bulging fontanelle. One of the points they raised is that cases with aseptic meningitis will be missed. However, the purpose of performing a lumbar puncture in infants with fever and bulging fontanelle is not to diagnose aseptic meningitis but...

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  • Re: ‘The information-seeking behavior of paediatricians accessing web-based resources’ (August 2009)
    Gillian Leng

    Dear editor,

    NHS Evidence welcomes any research that looks at the information- seeking behaviour of healthcare professionals and I am pleased to see that so many paediatricians use the internet as their ‘first port of call’ when looking to answer a medical question. It is also very interesting that over three quarters of pediatricians questioned find it difficult to keep up-to-date with new information relevant to...

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  • Bulging fontanelle in febrile infants: lumbar puncture is mandatory
    Sushil Beri

    We read with interest the study by Shacham et al [1]. Out of 153 children with fever and bulging fontanelle, only one child had bacterial meningitis. However we disagree with their suggestion of withholding lumbar puncture in this group of children. In their cohort, 41 out of 153 children had aseptic meningitis but CSF viral cultures and PCR studies were only done in children who have received antibiotics and had an abn...

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  • In response to Images in Paediatrics: A plethoric palm
    Dr Raakhee Ramesh

    The classification of vascular anomalies has been hampered historically by confusing and imprecise nomenclature. For example, the terms capillary haemangioma, portwine stain and naevus flammeus have all been used interchangeably to describe what should be more precisely referred to as capillary malformation.

    In the “Images in Paediatrics” section of ADC, August 2009 (1), Dr Adhisivam describes a 5-year-old boy...

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  • Paediatricians advocating for Consultation / Liaison Psychiatry
    Donald Payne


    Sebastian Kraemer writes that ‘the challenge for hospital paediatricians is to become advocates for a service that brings real benefits to their patients’ [1]. However, ‘because relatively few have seen what good liaison services can do, demand is not well articulated’ [1]. At Princess Margaret Hospital, the only tertiary hospital for children and adolescents in Western Australia, consultation / liaison...

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  • True value of PEWS is to improve awareness of what is happening rather than what’s going to happen
    John J Fitzsimons

    We were interested to read the study by Edwards et al on the predictive value of their paediatric early warning system (PEWS). They clearly identify the challenges inherent in designing triggers that have both a high sensitivity and specificity. We have an alternate understanding of what PEWS can deliver.

    We believe that true value of PEWS is as a situation awareness tool rather than a prediction tool for the...

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