Prospective surveillance study of the management of intussusception in UK and Irish infants

BACKGROUND

Intussusception is the most common cause of acute intestinal obstruction in infants. This study examined the clinical presentation, management and outcomes of intussusception in this age group.

METHODS

Prospective surveillance of intussusception in infants was carried out between March 2008 and March 2009 in the UK and Ireland. Monthly cards were sent to paediatric clinicians who were requested to notify cases of intussusception.

RESULTS

The study identified 261 confirmed cases. The commonest presenting symptom/sign was non-bilious vomiting, in 210 (80·5 per cent) of the infants. Abdominal ultrasonography was done in 247 infants (94·6 per cent) and was diagnostic in 242 (98·0 per cent), compared with plain abdominal X-ray, which was diagnostic in 33 (23·6 per cent) of 140 infants. Enema reduction was carried out in 240 (92·0 per cent) of the 261 infants; the majority (237, 98·8 per cent) had pneumatic reduction with a success rate of 61·2 per cent (145 of 237). Surgery was required in 111 infants (42·5 per cent); 92 operations were as a result of unsuccessful enema reduction, and the remaining 19 infants (17·1 per cent) had primary surgery. Forty-four infants (39·6 per cent of operations) needed a bowel resection. The majority of children (238, 91·2 per cent) recovered uneventfully; 21 (8·0 per cent) had sequelae, one child died (0·4 per cent), and the outcome was unknown for one infant.

CONCLUSION

This study described current treatment patterns for intussusception in infancy; these represent a benchmark for improved standards of care for this condition.

The Outcome of Severe Traumatic Brain Injury in Children in Qatar: Six year study

Traumatic brain injuries (TBI) are important public health problem resulting in short-term or permanent disability and death. To determine the extent and outcome of severe TBI amongst children in Qatar medical records were reviewed retrospectively of all cases of severe TBI in children aged 14 years or less who attended the Children Rehabilitation Unit, Hamad General Hospital, Qatar, between January 2002 to December 2008. The severity of TBI was assessed by the Glasgow Coma Scale (GCS). Of 65 children with severe TBI, most were male (73.8 %) and 91 % were older than five years of age. The leading causes of injury were road traffic accident (84.6%) and falls (10.8%). Other causes included trauma by ceiling fan blades (4.6%), sports and recreation injuries. Early sequelae included spasticity (43.1 %) and posttraumatic epilepsy (33.8%); both were significantly associated with the increased severity and need for intracranial surgery. Almost a quarter of the children had communication disorders, 17 (26.2 %) had poor cognition, 16 (24.6%) had hemiplegia and 12 (18.5 %) had abnormal behaviour. Twelve (18.5%) children died within the first month of admission to hospital. It is clear that severe TBI results in significant morbidity and mortality among children in Qatar and special efforts are needed to reduce the causes especially motor vehicle crashes and injuries. Rehabilitation programs are also needed to limit the extent of long-term complications associated with TBI.

Immunisations among school leavers: is there a place for measles-mumps-rubella vaccine?

To ascertain measles-mumps-rubella (MMR) immunisation coverage among school leavers in an inner city London borough following a local MMR catch-up initiative, a questionnaire was sent to parents and guardians of adolescents who attended the 12 secondary schools in Haringey and were due for the school leavers' vaccination. The questionnaire enquired about previous history of MMR vaccination and a history of adverse events or contraindications to the vaccine. The electronic immunisation records of 400 children (30-35 students from each school) included in the catch up initiative were randomly selected. The childrens' school health records were manually compared with the electronic records. The mean age of the children was 14.7 years, and 224 (56%) were male. Of the 373 records examined prior to the local MMR catch-up initiative, 98 children (26%) had never received MMR, 173 (46.5%) had only had one dose, 100 (27%) had two doses, and two children had three doses of the vaccine. During the school leavers' MMR immunisation, 171 (43%) received a dose of MMR and the number of children immunised with two doses increased to 206 (55.3% versus 27% P<0.001), doubling the coverage. Offering MMR vaccination as part of the school leavers immunisation is logistically convenient and it may limit the extent of outbreaks.

Viral respiratory infections at the Hajj: comparison between UK and Saudi pilgrims

A high incidence of respiratory infection, including influenza, has been reported at the Hajj in Mecca, Saudi Arabia. Reported rates of influenza have been higher among UK than among domestic pilgrims, but this could be explained by methodological differences among studies. Accordingly, the present study compared the frequencies of respiratory viruses among UK and Saudi pilgrims using the same study design. Pilgrims with upper respiratory tract symptoms were recruited from Mecca and the neighbouring valley Mina during the Hajj 2006. Nasal swabs were used for point-of-care influenza testing and real-time RT-PCR (rtRT-PCR) tests for influenza virus, rhinovirus, parainfluenza virus, adenovirus, human metapneumovirus and respiratory syncytial virus. Of 260 pilgrims investigated, 150 were from the UK and 110 were Saudi; of these, 38 (25%) UK pilgrims and 14 (13%) Saudi pilgrims had respiratory infections detectable by rtRT-PCR (p 0.01). In the UK group, there were 19 (13%) cases of rhinovirus infection, 15 (10%) cases of influenza virus infection, two (1%) cases of dual infections with influenza virus and rhinovirus, one (3%) case of parainfluenza virus infection, and one (1%) case of respiratory syncytial virus infection. Fifty-six (37%) UK pilgrims had been vaccinated against influenza virus, with the rates of influenza in the vaccinated and unvaccinated group being 7% and 14%, respectively (p 0.19). In the Saudi group, there were three (3%) cases of rhinovirus infection and 11 (10%) cases of influenza. Only four (4%) Saudi pilgrims had been vaccinated against influenza virus, and none of these was infected with influenza virus. Overall, a significantly higher proportion of the UK pilgrims had detectable respiratory infections (25% vs. 13%, p 0.01). Influenza rates were similar in both groups, but the reported rates of influenza vaccination differed.

Influenza and respiratory syncytial virus infections in British Hajj pilgrims

Viral respiratory infections including influenza and respiratory syncytial virus (RSV) have been reported during the Hajj among international pilgrims. To help establish the burden of these infections at the Hajj, we set up a study to confirm these diagnoses in symptomatic British pilgrims who attended the 2005 Hajj. UK pilgrims with symptoms of upper respiratory tract infection (URTI) were invited to participate; after taking medical history, nasal swabs were collected for point-of-care testing (PoCT) of influenza and for subsequent PCR analysis for influenza and RSV. Of the 205 patients recruited, 37 (18%) were positive for either influenza or RSV. Influenza A (H3) accounted for 54% (20/37) of the virus-positive samples, followed by RSV 24% (9/37), influenza B 19% (7/37), and influenza A (H1) 3% (1/37). Of the influenza-positive cases, 29% (8/28) had recently had a flu immunisation. Influenza was more common in those who gave a history of contact with a pilgrim with a respiratory illness than those who did not (17 versus 9%). The overall rate of RSV was 4% (9/202). This study confirms that influenza and RSV cause acute respiratory infections in British Hajj pilgrims. Continuing surveillance and a programme of interventions to contain the spread of infection are needed at the Hajj, particularly when the world is preparing for an influenza pandemic.

Diagnosis and treatment of bacterial meningitis

This review focuses on recent advances of topical interest regarding the diagnosis and treatment of common causes of bacterial meningitis occurring in children beyond the neonatal period. Tuberculous meningitis is beyond the scope of this review.