Published on 17 July 2018
Measuring oxygen levels in newborn babies as part of routine care can identify cases of critical congenital heart defects sooner than waiting until symptoms appear. If 10,000 babies were screened, pulse oximetry could correctly identify about 5 of the 6 expected asymptomatic cases and might miss one. This international research suggests there would be about 14 false alarms. Waiting until babies are at least 24 hours old minimises the number of these false positives.
Babies with critical heart defects often show no symptoms at birth. Early detection of these problems increases the chance of successful treatment. This systematic review looked at 21 studies of 457,202 babies where pulse oximetry (measuring the amount of oxygen in the blood using a device put on the hand or foot) was used as a simple screening test.
Pulse oximetry correctly identifies 76.3% of babies who have critical congenital heart defects. It also correctly identifies 99.9% of healthy babies without problems.
Current UK newborn screening programmes do not include pulse oximetry because a national pilot scheme suggested there would be higher false positive results in routine NHS practice.
Link to article here
As the NHS prepares to mark its 70th anniversary, the Clinical Director at the South London Partnership, Child and Adolescent Mental Health (CAMHS) programme outlines how the New Care Models are leading an ambitious transformation of mental health, aspiring to help an extra million people with high-quality care supported by £1 billion additional investment:
‘You’re the commissioner, what would you do for south London’s children and young people?’
This was one of the questions we posed to clinicians and operational managers at a recent South London Mental Health and Community Partnership workshop.
Five years ago, it would have been hard to imagine such conversations or challenges, covering a population of more than three million people. Or that our three mental health trusts would plan system-wide services together. And even less that the innovations and ideas would become reality.
Thanks to NHS England Children and Adolescent Mental Health (CAMHS) tier 4 New Care Models programme, and the collaboration between Oxleas NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, and South West London and St George’s Mental Health Trust, our clinicians and managers are working together for genuine transformation.
Three trusts that once competed are now collaborating and sharing approaches, pathways, resources and clinical expertise – all for the benefit of some of the most vulnerable of our children and young people.
Link to blog page here
NHS England’s National Clinical Director for Children and Young People highlights how the journey to integrated care presents a real opportunity to join up pathways around the needs of children and families:
Often our narrative about the challenges facing health and care is dominated by a very adult view of the world.
Writ large are the issues of an ageing population and people living longer with multiple conditions.
At the other end of the spectrum we have babies, children, young people and their families who are starting a lifelong association with our health services, and where early intervention and prevention can have the greatest and most lasting impact.
Successful programmes, such as immunisation, help to get infants off to the best start in life. Many children, unfortunately, have long-term conditions – diabetes, epilepsy and asthma – and complex health issues, like neurodisability, which continue into adulthood.
We know that half of all lifetime mental health illness can be diagnosed at the age of 14 so early intervention will alter the life chances of these young people.
We also face the increasing and serious prevalence of childhood obesity. Overweight children are more likely to require more medical care, be absent from school, experience health-related limitations and have mental health problems. The risks of going on to develop Type 2 Diabetes are also higher.
Managing these systemic problems is complex and the reality is that no hospital or GP surgery can tackle them alone. The way we are working now must change as demands on our GPs, hospitals, community services and social care continue to rise.
Link to full article here
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Moxifloxacin is not approved by the US Food and Drug Administration for pediatric use. Although its use might be indicated under certain conditions, data regarding its safety and tolerability in pediatric patients are limited. The primary objective of this study was to evaluate the safety of systemic moxifloxacin therapy in children.
We conducted a retrospective observational study of patients aged <18 years who received oral or intravenous moxifloxacin at our institution between January 2011 and July 2016. Patient demographics, clinical characteristics, indication for moxifloxacin use, and adverse events (AEs) were extracted via chart review. The attribution of AEs to moxifloxacin use was adjudicated in consultation with a pediatric infectious disease (ID) pharmacist.
We identified 221 patients who received 300 courses of moxifloxacin. The average age at moxifloxacin initiation was 10.4 years. One or more AEs occurred during 195 (65%) of the courses. Of the 463 distinct AEs, 46 (9.9%) were attributed to moxifloxacin. AEs attributed to moxifloxacin included corrected QT interval (QTc) prolongation (18 [6%] courses), transaminase level elevation (7 [2.3%] courses), and increased bilirubin level (3 [1%] courses). AEs led to moxifloxacin discontinuation in 18 (6%) courses. ID consultation was associated with QTc (P < .001) and transaminase (P= .002) monitoring.
AEs that occur during pediatric moxifloxacin therapy are relatively common but rarely serious enough to require premature discontinuation. The drug might be used safely in most children with monitoring, including evaluation for QTc prolongation, and guidance from ID specialists.
Link to article page here
Question How do infant feeding practices influence gut microbiota and risk of overweight?
Findings Among 1087 infants from the Canadian Healthy Infant Longitudinal Development (CHILD) cohort, earlier cessation of breastfeeding and supplementation with formula (more so than complementary foods) were associated with a dose-dependent increase in risk of overweight by age 12 months; this association was partially explained by specific gut microbiota features at 3 to 4 months. Subtle but significant microbiota differences were observed after brief exposure to formula limited to the birth hospital stay, but these differences were not associated with overweight.
Meaning Breastfeeding may contribute to protection against overweight by modifying the gut microbiota, particularly during early infancy.
Link to article page here