Temple Street Research Articles

Circulating rotavirus genotypes in the Irish paediatric population prior to the introduction of the vaccination programme.

Rotavirus is the leading cause of viral gastroenteritis in children, and it is anticipated that the introduction of the Rotarix™ vaccine (GlaxoSmithKline Biologicals S.A., Rixensart, Belgium) into the Irish immunisation schedule will result in a significant reduction of rotavirus-associated disease. In the pre- and post-vaccination eras, it is important to determine circulating strains of rotavirus to assess vaccine effectiveness, to monitor vaccine failures, and to detect potential emerging strains. This study was a collaboration between the Temple Street Children's University Hospital (TSCUH), Dublin, and the National Virus Reference Laboratory (NVRL), Dublin, to determine the then circulating rotavirus strains in a paediatric hospital. In the 2015/2016 period (July 2015-June 2016) 89 faecal samples from paediatric patients (53 from TSCUH, 36 from other hospitals) were characterised. The results showed G1P[8] to be the predominant genotype (57%), followed by G9P[8] (34%), G4P[8] (6%), G2P[4] (2%), and G12P[8] (1%). This distribution of genotypes is comparable to those found in other European countries prior to vaccination suggesting that the vaccine should be highly efficacious in the Irish population.

Exploring the usability of a mobile app for adolescent obesity management

Background: Obesity is a global epidemic. Behavioral change approaches towards improving nutrition, increasing physical activity level, improving sleep, and reducing sitting time are recommended as best practices in adolescent obesity management. However, access to evidence-based treatment is limited and portable technologies such as mobile apps may provide a useful platform to deliver such lifestyle interventions. No evidence-based validated app exists for obesity intervention; therefore, a novel mobile app (Reactivate) was developed for use in the Temple Street W82GO Healthy Lifestyles Program (W82GO). Objective: This study aimed to test the usability (technical effectiveness, efficiency, and user satisfaction) of the Reactivate mobile app in obese adolescents. Methods: Ten adolescents (7 males and 3 females, aged 12-17 years) who had been treated for obesity (>98th percentile for body mass index) at the Temple Street Children's University Hospital were recruited. Participants were given 8 tasks to complete in order to test the technical effectiveness of the app. A research assistant timed the user while completing each task in order to test the relative user efficiency of the app (time-on-task). The tasks fell into 5 categories and required the user to enter personal settings, find and answer surveys, create a message, use the goal setting feature, and enter details regarding their weight and height. In exploration of user satisfaction, each participant completed the standardized software usability measurement inventory (SUMI), which measures 5 aspects of user satisfaction: efficiency, effect, helpfulness, controllability, and learnability. Descriptive statistics were used to explore the mean relative user efficiency and SUMI scores. Results: Mean age was 14.26 (SD 1.58) years. All adolescents completed each of the tasks successfully. The mean relative user efficiency scores were two to three times that of an expert user. Users responded that they would use Reactivate to monitor their growth over time, for motivation, and for goal setting. All users described Reactivate as an important mobile app. Conclusions: Our study describes the usability of a mobile app used in adolescent obesity management. Adolescents found Reactivate easy to use and their SUMI results indicated that the app scored high on user satisfaction. Usability testing is an important step towards refining the development of the Reactivate app, which can be used in the treatment of obesity. The study on the clinical efficacy of the Reactivate app is currently underway. [JMIR Mhealth Uhealth 2014;2(2):e29]

LG-48PAEDIATRIC LOW GRADE GLIOMAS - IMPACT OF GROSS TOTAL RESECTION IN A SINGLE CENTRE COHORT

LG-48. PAEDIATRIC LOW GRADE GLIOMAS IMPACT OF GROSS TOTAL RESECTION IN A SINGLE CENTRE COHORT Noelle Cullinan1, John Caird2, Michael Capra1, Jane Pears1, Cormac Owens1, andDarachCrimmins2; DepartmentofHaematology/Oncology,Our Lady’s Children’s Hospital, Dublin, Ireland; Department of Paediatric Neurosurgery, Children’s University Hospital, Temple Street, and Beaumont Hospital, Dublin, Ireland AIMS: Completely excised paediatric low grade gliomas (LGGs) are associated with excellent survival rates. Complete resection is not always achievable. We reviewed the Irish neurosurgical experience of paediatric LGGs over a 10-year period. METHODS: We performed a retrospective review of all paediatric patients with LGG diagnosed in the Republic of Ireland between 2005-2014. RESULTS: 112 children were diagnosed over a 10-year period (52 male (46%), 60 female (53%), Age range 0.23–15.87 years, Mean 7.03 years, Median 6.3 years). 111 children had surgical procedures – 14 (13%) had biopsies alone, 16 (14%) had biopsies followed by later resections, while 79 (71%) had upfront craniotomies with resection. We were unable to identify the type of procedure in 2 children. 1 child had a radiological diagnosis of aLGG but no confirmatorybiopsy.79 patientshadupfront craniotomies. In 77/79, all required information was available. 40/77 (52%) had Gross Total Resection (GTR) confirmed by post-operative imaging and 37/77 (48%) had incomplete resections. Of those who had GTR confirmed (excluding patients with Neurofibromatosis Type 1), 3 patients (4%) relapsed or had disease progression in follow-up, with early progression noted, all within 15 months after resection. All others are currently disease free in follow up (96%). CONCLUSION: In those with confirmed GTR on post-operative imaging, recurrence, if it occurred, was early. We propose that scanning intervals can be increased after 2 years and ongoing need for imaging surveillance in those with confirmed GTR should be reviewed. Neuro-Oncology 18:iii78–iii96, 2016. doi:10.1093/neuonc/now075.48 #The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Delayed Infant Subaponeurotic (Subgaleal) Fluid Collections: A Case Series of 11 Infants

BackgroundAlthough subgaleal hemorrhage can present very soon after delivery with catastrophic consequences, subaponeurotic or subgaleal fluid collections are rare and clinically distinct causes of infant scalp swelling that present weeks to months after birth. Their exact etiology remains uncertain; however, they are frequently associated with instrumental and traumatic delivery. Aim & MethodsTo characterize 11 subaponeurotic fluid collections that presented to the Temple Street Children's University Hospital Emergency Department (TSCUHED) from July 2013 to July 2015 by a retrospective chart review. Case ReportEleven infants were identified with delayed subaponeurotic fluid collections. Of note, all infants were either successful vacuum delivery or failed vacuum delivery with subsequent forceps delivery or emergency caesarean section. All infants were otherwise well at presentation, and resolution of the scalp swelling occurred within weeks to months. Why Should an Emergency Physician Be Aware of This?This condition follows a benign course and conservative management is the treatment of choice.

Holoprosencephaly: antenatal and postnatal diagnosis and outcome.

The objectives of this study are to ascertain the clinical outcome and overall survival of holoprosencephaly (HPE) patients diagnosed antenatally and postnatally, to determine the accuracy of antenatal diagnosis and to determine the role of neurosurgical intervention in HPE. This is a retrospective review over a 10-year period. Sixty-three patients were included in the study, 45 were diagnosed by antenatal radiological imaging and 18 were diagnosed by postnatal radiological imaging. Patient data was drawn from Temple Street Children's University Hospital (the national paediatric neurosurgery centre), the National Maternity Hospital in Holle's Street, Dublin, and Our Lady of Sick Children Hospital, Dublin. The study was carried out through a review of antenatal and postnatal radiological imaging and reports, clinical charts, GP letters from patient follow-up and telephone conversations with parents of HPE patients. Four patients in the antenatal diagnosis group had follow-up foetal MRI confirming HPE. Twelve in this group had radiological follow-up postnatally, and in five of these, HPE was confirmed. The remaining seven were identified as false positive. Alobar HPE constituted 55% (21/38) of patients with 95% mortality. Fifty-one percent had a normal karyotype. The overall survival in the antenatal diagnosis group was 13%. In the postnatal group, 18 patients were identified, 67% (12/18) lobar and 33% (6/18) semilobar. Normal karyotype was found in 72% (13/18), with an overall survival rate of 56% (10/18). Neurosurgical intervention in both groups mainly consisted of CSF diversion in the form of ventriculoperitoneal (VP) or cystoperitoneal shunt (CP) (13/67). Foetal MRI should be routinely performed in suspected cases of HPE, and reliance on ultrasound alone in the antenatal period may not be sufficient. In our study, there is a high early mortality noted in severe cases of HPE, while milder forms of HPE in children tend to survive beyond infancy albeit with associated complications that required neurosurgical intervention and medical management for other associated systemic anomalies.

An international survey of pediatric physical therapist researchers: assessing qualifications, resources and needs among pediatric physical therapists researchers

M.E. O‘Neil 1, N. Shields 2, G. O‘ Malley 3, G.K. Oberg 4, A.F. Van Sant 5 1 Drexel University, Department of Physical Therapy and Rehabilitation Sciences, Philadelphia, PA, United States; 2 La Trobe University, Department of Physiotherapy, Melbourne, Australia; 3 Temple Street Children’s University Hospital, Physiotherapy Department, Dublin, Ireland; 4 UiT The Arctic University of Norway, Department of Health and Care Sciences, Tromso, Norway; 5 Temple University, Department of Physical Therapy, Philadelphia, PA, United States

Evaluation of a novel susceptibility weighted imaging MRI sequence for neonate brain scanning

Evaluation of a novel susceptibility weighted imaging MRI sequence for neonate brain scanning

Exploring the Usability of a Mobile App for Adolescent Obesity Management

BackgroundObesity is a global epidemic. Behavioral change approaches towards improving nutrition, increasing physical activity level, improving sleep, and reducing sitting time are recommended as best practices in adolescent obesity management. However, access to evidence-based treatment is limited and portable technologies such as mobile apps may provide a useful platform to deliver such lifestyle interventions. No evidence-based validated app exists for obesity intervention; therefore, a novel mobile app (Reactivate) was developed for use in the Temple Street W82GO Healthy Lifestyles Program (W82GO).ObjectiveThis study aimed to test the usability (technical effectiveness, efficiency, and user satisfaction) of the Reactivate mobile app in obese adolescents.MethodsTen adolescents (7 males and 3 females, aged 12-17 years) who had been treated for obesity (>98th percentile for body mass index) at the Temple Street Children's University Hospital were recruited. Participants were given 8 tasks to complete in order to test the technical effectiveness of the app. A research assistant timed the user while completing each task in order to test the relative user efficiency of the app (time-on-task). The tasks fell into 5 categories and required the user to enter personal settings, find and answer surveys, create a message, use the goal setting feature, and enter details regarding their weight and height. In exploration of user satisfaction, each participant completed the standardized software usability measurement inventory (SUMI), which measures 5 aspects of user satisfaction: efficiency, effect, helpfulness, controllability, and learnability. Descriptive statistics were used to explore the mean relative user efficiency and SUMI scores.ResultsMean age was 14.26 (SD 1.58) years. All adolescents completed each of the tasks successfully. The mean relative user efficiency scores were two to three times that of an expert user. Users responded that they would use Reactivate to monitor their growth over time, for motivation, and for goal setting. All users described Reactivate as an important mobile app.ConclusionsOur study describes the usability of a mobile app used in adolescent obesity management. Adolescents found Reactivate easy to use and their SUMI results indicated that the app scored high on user satisfaction. Usability testing is an important step towards refining the development of the Reactivate app, which can be used in the treatment of obesity. The study on the clinical efficacy of the Reactivate app is currently underway.

G32(P) Benign Acute Childhood Myositis: Clinical Presentation in an Emergency Department

<h3>Aims</h3> To describe the demographics and clinical presentation of children who attended the emergency department of Temple Street hospital with acute onset difficulty in walking or refusal to walk and who were subsequently diagnosed with benign acute myositis. <h3>Methods</h3> We collected a list of all the ED patients who had a raised Creatinine kinase result from the pathology laboratory. We used the Emergency Department Clinical Information System, Symphony to review the medical records of these children and collect the data we needed. <h3>Results</h3> Fifty one (51) children, (40 males and 11 females) were seen with clinical myositis and raised Creatinine kinase levels between November and February of 2012–2013. Mean age was 5.9 years. Twenty eight (54.9%) presented with leg pain, sixteen (29.4%) non-weight bearing and seven (5.9%) with difficulty walking. 64.7% of these patients had calf tenderness, 5.9% had thigh tenderness and in 29.4% muscle tenderness was not clearly documented in the clinical notes. There was evidence of concurrent viral disease in thirty one (61%) of these patients with nineteen (37.2%) having had a viral illness in the preceding week. Creatinine Kinase levels were elevated in all patients with levels ranging from 183 – 7584. <h3>Conclusion</h3> Benign acute childhood myositis (BACM) is a syndrome more commonly seen in childhood typically affecting males. Symptoms include calf pain and refusal or difficulty to walk, often after a viral illness. It has been epidemiologically linked to Influenza virus. Previous studies have described much fewer cases. The Temple street University Hospital emergency department (ED) is one of the busiest in Western Europe and in the 2012/2013 winter months we did experience a surge of children with this history. BACM can be differentiated from other more serious causes of difficulty walking in children by the presence of calf tenderness in the presence of otherwise normal lower limb exam on a background of concurrent or preceding viral illness as shown in this study. These children may not necessarily need extensive investigation or routine follow up but can be discharged with appropriate advice to parents to seek review if symptoms continue.

G19 An evaluation of fracture clinic referrals in Ireland’s busiest Paediatric Emergency Department

BackgroundInjuries account for about 18% of all paediatric emergency department presentations. Of these, a significant amount will have fractures that will require orthopaedic follow-up. These clinics tend to be very...

A smartphone intervention for adolescent obesity: study protocol for a randomised controlled non-inferiority trial

BackgroundThere are few evidence-based mobile health solutions for treating adolescent obesity. The primary aim of this parallel non-inferiority trial is to assess the effectiveness of an experimental smartphone application in reducing obesity at 12 months, compared to the Temple Street W82GO Healthy Lifestyles intervention.Methods/designThe primary outcome measure is change in body mass index standardised deviation score at 12 months. The secondary aim is to compare the effect of treatment on secondary outcomes, including waist circumference, insulin sensitivity, quality of life, physical activity and psychosocial health. Adolescents with a body mass index at or above the 98th percentile (12 to 17 years) will be recruited from the Obesity clinic at Temple Street Children’s University Hospital in Dublin, Ireland. W82GO is a family-based lifestyle change intervention delivered in two phases over 12 months. In the current study, participants will be randomised for phase two of treatment to either usual care or care delivered via smartphone application. One hundred and thirty-four participants will be randomised between the two study arms. An intention-to-treat analysis will be used to compare treatment differences between the groups at 12 months.DiscussionThe results of this study will be disseminated via open access publication and will provide important information for clinicians, patients and policy makers regarding the use of mobile health interventions in the management of adolescent obesity.Trial registrationClinicaltrials.gov NCT01804855.

A Historical Perspective of Pediatric Publications: A Bibliometric Analysis

* Abbreviations: WoS — : Thompson Reuters Web of Science > What kinds of pediatric articles are cited most often? One might expect the answer to be classic research studies, both clinical and basic science. The authors of this review identified the top 100 most cited pediatric articles since 1945, and found a different and perhaps surprising answer. > > —Jeffrey P. Baker, MD, PhD > > Section Editor, Historical Perspectives The world of medical research is rapidly proliferating. Since 1945 there have been more than 40 million publications referenced on the Thompson Reuters Web of Science (WoS). Pediatric academia has been in existence since 1471 with Bagallarder's Little Book on Disease in Children .1 However, pediatrics as a specialized field of medicine only developed in the mid-19th century. Archives in Pediatrics was the first pediatric journal and was established in 1884. The very first pediatric publication was “Convulsions in Children” by William T. Plant.2 Since then, the number of publications on the subject of pediatrics has dramatically expanded. There are now 191 journals solely dedicated to the specialty of pediatrics and in 2010 alone, more than 22 800 pediatric articles were published. Bibliometric methods, including citation analysis, have been used to evaluate trends in publications within specialties including neonatal surgery.3 They have also been used to examine highly cited articles within a specialty,4 providing insight into what types of article are of importance and interest to the readership. In this article, we identify and analyze the top 100 most frequently cited articles published in journals dedicated to pediatrics between 1945 and 2010. … Address correspondence to Dermot Thomas McDowell, MRCS, Department of Pediatrics, Children’s University Hospital, Temple Street, Dublin 1, Ireland. E-mail: dermcd{at}yahoo.com

Dose Optimisation in Paediatric CT – the Temple Street Children's University Hospital Experience

Dose Optimisation in Paediatric CT – the Temple Street Children's University Hospital Experience

PANTHER AND BULLDOG: RECALLING MAY DAY 1970

5 2 Y P A N T H E R A N D B U L L D O G R E C A L L I N G M A Y D A Y 1 9 7 0 P E T E R B R O O K S You couldn’t have asked for a brighter May Day – clear sky, the sun already warm when I walked the short mile from my house on Edwards Street down Whitney Avenue and Temple Street as the walls and turrets of Yale University began to define themselves before me. At the intersection of Grove Street, just down the road from the historic cemetery with its pseudo-Egyptian gateway proclaiming that the dead shall be raised, I came upon the sight I had been partly expecting – and dreading. But its reality was more than I was prepared for. The Connecticut National Guard in troop carriers and jeeps, deployed all along Grove Street, thus forming a cordon for the demonstration that was about to begin on the New Haven Green. What struck me most was the provocation of their weapons, out in plain view, pointing every which way. They looked neither disciplined nor alert; they weren’t in formation. They just looked sinister. It was only later that I learned that those rifles they displayed so conspicuously contained live ammunition. On 4 May would come the Kent State shootings, when the National Guard opened fire on student demonstrators. Those shootings might have occurred at Yale. My walk to Timothy Dwight College (one of Yale’s twelve 5 3 R undergraduate residences), in preparation for moving on to the Green at 4 p.m., wasn’t exactly to participate in the demonstration in support of Black Panther leader Bobby Seale, on trial in the New Haven courthouse, which fronts the Green, for conspiracy in the murder of Alex Rackley, a nineteen-year-old Panther recruit whose tortured body had been found in a swamp near Middlefield, Connecticut, where it had been dumped after he was shot as a traitor by Warren Kimbro, a model leader of black youth in New Haven who had also joined the Panthers. Orders to ‘‘execute’’ Rackley had been brought from Oakland Panther headquarters; the theory of the prosecution was that their source was Bobby Seale. The prosecution’s case eventually proved very weak, however , entirely dependent on the testimony of one notoriously unreliable informant (George Sams, I.Q. 75), and Seale was never convicted. But Bobby Seale had become something of an obsession to J. Edgar Hoover and the o≈ce he established, cointelpro, to monitor political radicals intent on undoing the U.S. government. (A fine source of information on all this is the book by Paul Bass and Douglas Rae, Murder in the Model City, 2006.) I was on my way to Timothy Dwight in order to form part of a ‘‘faculty presence’’ among the students for this ominous Friday, 1 May 1970, which would see a weekend-long demonstration to ‘‘free Bobby’’ on the Green. I was part of the ‘‘monitoring committee’’ created by William Sloane Co≈n, Yale’s chaplain and a celebrated leader in the civil rights and antiwar movements, who had undertaken to negotiate between Yale and the city of New Haven – especially, the chief of police – to try to minimize the damage that might occur in this gathering that promised to include representatives of all of radical America, even some of its violent elements. The immediate provocation to the rally came early in the judicial proceedings against Seale and two colleagues: the judge sentenced two of the defendants, David Hilliard and Emory Douglas, to six monthsinprisonforcontemptofcourtforarelativelyminorinfraction of courtroom etiquette. Seale himself was already serving a prison sentence as part of the ‘‘Chicago Eight,’’ and the photos of him bound and gagged at the order of Chicago Judge Julius Ho√man had become the stu√ of posters. The trial in New Haven seemed to left-wing America like one more attempt to destroy the Black Panthers. Who gave the word to assemble in New Haven on 1 5 4 B R O O K S Y May isn’t clear...

Prenatal identification of an accessory lower limb

Prenatal DiagnosisVolume 31, Issue 12 p. 1203-1204 Research Letter Prenatal identification of an accessory lower limb J. Unterscheider, Corresponding Author J. Unterscheider [email protected] Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland Julia Unterscheider, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland. E-mail: [email protected]Search for more papers by this authorJ. O'Byrne, J. O'Byrne Department of Neonatology, Rotunda Hospital, Dublin, IrelandSearch for more papers by this authorA. Foran, A. Foran Department of Neonatology, Rotunda Hospital, Dublin, IrelandSearch for more papers by this authorI. Robinson, I. Robinson Department of Radiology, Children's University Hospital, Temple Street, Dublin, IrelandSearch for more papers by this authorS. Ryan, S. Ryan Department of Radiology, Children's University Hospital, Temple Street, Dublin, IrelandSearch for more papers by this authorD. Devaney, D. Devaney Department of Pathology, Rotunda Hospital, Dublin, IrelandSearch for more papers by this authorJ. Gillick, J. Gillick Department of Surgery, Children's University Hospital, Temple Street, Dublin, IrelandSearch for more papers by this authorF. Malone, F. Malone Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, IrelandSearch for more papers by this authorF. Breathnach, F. Breathnach Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, IrelandSearch for more papers by this author J. Unterscheider, Corresponding Author J. Unterscheider [email protected] Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland Julia Unterscheider, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland. E-mail: [email protected]Search for more papers by this authorJ. O'Byrne, J. O'Byrne Department of Neonatology, Rotunda Hospital, Dublin, IrelandSearch for more papers by this authorA. Foran, A. Foran Department of Neonatology, Rotunda Hospital, Dublin, IrelandSearch for more papers by this authorI. Robinson, I. Robinson Department of Radiology, Children's University Hospital, Temple Street, Dublin, IrelandSearch for more papers by this authorS. Ryan, S. Ryan Department of Radiology, Children's University Hospital, Temple Street, Dublin, IrelandSearch for more papers by this authorD. Devaney, D. Devaney Department of Pathology, Rotunda Hospital, Dublin, IrelandSearch for more papers by this authorJ. Gillick, J. Gillick Department of Surgery, Children's University Hospital, Temple Street, Dublin, IrelandSearch for more papers by this authorF. Malone, F. Malone Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, IrelandSearch for more papers by this authorF. Breathnach, F. Breathnach Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, IrelandSearch for more papers by this author First published: 05 September 2011 https://doi.org/10.1002/pd.2846Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume31, Issue12December 2011Pages 1203-1204 RelatedInformation

Introduction

Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT Reprints: Martin H. Floch, MD, Yale University School of Medicine, Section of Digestive Diseases, 40 Temple Street, Suite 1A, New Haven, CT 06510 (e-mail: [email protected]).

1239 Causes of Childhood Mortality: 10 Year Audit of Post Mortem Examinations in Cuh Temple Street, Dublin

Background: Despite the marked reduction in SIDS, the rate of childhood mortality has remained fairly constant. Many childhood deaths are unexpected and potentially avoidable. Aim: To analyse data relating to all deaths in CUH, Temple Street, and to assess the feasibility of establishing a National Enquiry in order to identify avoidable factors in childhood death. Methods: We conducted a retrospective review of all post mortems reported over ten years. Deaths were analysed and classified as follows: expected or unexpected; unavoidable, avoidable or potentially avoidable. Results: 246 autopsies were studied. 78% were performed at the direction of a coroner. 11 deaths (4.5%) were referred to the State Pathologist. Deaths were categorised into the following groups; SIDS, (33.7%), infection (19.1%), neurological and metabolic disease (16.7%), injury/suicide (13.4%), cardiac (4.9%), miscellaneous (12.2%). A marked reduction in SIDS was noted reflecting national trends. Of the deaths attributed to accidental injury almost two thirds were in boys. All of these deaths were deemed potentially avoidable or avoidable. Of the total number of deaths at least 48% were unexpected. Just over half the deaths undergoing post mortem were avoidable or potentially avoidable. Conclusion: Our data highlights the reasons why children die in an Irish population. Our ability to assess all associated factors in detail was limited by the data available. Establishing a national enquiry into paediatric mortality would provide information to the avoidable factors associated with childhood deaths. This could inform institutional policies and public health measures to reduce the incidence of untimely and preventable deaths.

Basiliximab induced non-cardiogenic pulmonary edema in two pediatric renal transplant recipients

We report two cases of non-cardiogenic pulmonary edema as a complication of basiliximab induction therapy in young pediatric renal transplant patients identified following a retrospective review of all pediatric renal transplant cases performed in the National Paediatric Transplant Centre, Childrens University Hospital, Temple Street, Dublin, Ireland. Twenty-eight renal transplantations, of which five were living-related (LRD) and 23 were from deceased donors (DD), were performed in 28 children between 2003 and 2006. In six cases, transplantations were pre-emptive. Immunosuppression was induced pre-operatively using a combination of basiliximab, tacrolimus and methylprednisolone in all patients. Basiliximab induction was initiated 2 h prior to surgery in all cases and, in 26 patients, basiliximab was re-administered on post-operative day 4. Two patients, one LRD and one DD, aged 6 and 11 years, respectively, developed acute non-cardiogenic pulmonary edema within 36 h of surgery. Renal dysplasia was identified as the primary etiological factor for renal failure in both cases. Both children required assisted ventilation for between 4 and 6 days. While both grafts had primary function, the DD transplant patient subsequently developed acute tubular necrosis and was eventually lost within 3 weeks due to thrombotic microangiopathy and severe acute antibody-mediated rejection despite adequate immunosuppression. Non-cardiogenic pulmonary edema is a potentially devastating post-operative complication of basiliximab induction therapy in young pediatric patients following renal transplantation. Early recognition and appropriate supportive therapy is vital for patient and, where possible, graft survival.

Parsing Risk for the Use of Selective Serotonin Reuptake Inhibitors in Pregnancy

Parsing Risk for the Use of Selective Serotonin Reuptake Inhibitors in Pregnancy

Relationship between perceptual ratings of nasality and nasometry in children/adolescents with cleft palate and/or velopharyngeal dysfunction

Nasometry has supplemented perceptual assessments of nasality, using speech stimuli, which are devoid of nasal consonants. However, such speech stimuli are not representative of conversational speech. A weak relationship has been found in previous studies between perceptual ratings of hypernasality and nasalance scores for passages containing nasal consonants. This study aimed to evaluate the relationship between perceptual assessment and acoustic measurements of nasality using controlled speech stimuli. A perceptual scale (the Temple Street Scale) describing nasality was devised for this study. Fifty children presenting with nasality were assessed using the Temple Street Scale and nasalance scores were obtained for specified speech samples using the Nasometer (Kay Elemetrics 6200.3). The relationship between the perceptual ratings and the nasometry results was evaluated using correlation analysis, test sensitivity, specificity, and overall efficiency. Correlation coefficients for perceptual ratings of nasality and nasalance scores ranged from 0.69 to 0.74. The sensitivity of the Nasometer ranged from 0.83 to 0.88; its specificity ranged from 0.78 to 0.95; while its overall efficiency was between 0.82 and 0.92. The strong relationship between perceptual and acoustic assessments of nasality indicated that the Temple Street Scale and the Nasometer are both valid clinical tools for the evaluation of nasality when a carefully constructed speech sample is used. The need to use the Nasometer as a supplement to perceptual assessment is highlighted.