Traditionally, oral corticosteroids (OCSs) have been the mainstay of treatment for acute wheezing episodes among preschool children with history of recurrent wheezing. Although there is substantial evidence for the efficacy of OCSs as a treatment for asthma exacerbations in school-aged children and adolescents, recent clinical studies questioned the benefits of OCSs as a treatment for acute wheezing in preschool children. This review summarizes the current evidence on the efficacy of OCSs as a treatment for acute wheezing episodes among preschool age children with episodic wheezing focusing on studies performed in three different settings: OCSs treatment initiated by the parents in the outpatient setting, OCSs initiated in the Emergency Department (ED), and OCSs treatment among hospitalized preschool children. The results of most studies reviewed in this paper do not support the efficacy of OCS treatment among preschool children with recurrent wheezing. The heterogeneity of early childhood wheezing and asthma might be part of the explanation for lack of efficacy of this intervention noted in multiple studies.

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We describe a rare and devastating complication of a malpositioned scalp peripheral intravenous catheter (PIV) that resulted in subdural extravasation of infused fluids and midline shift in a critically ill neonate who required extracorporeal membrane oxygenation (ECMO). Recognition of increased intracranial pressure was hindered by the hemodynamic changes of being on ECMO and only identified by routine surveillance ultrasonography. Awareness of this complication may lead providers to seek alternate sites for vascular access in such patients, and encourage closer monitoring for this complication when an alternate site is unavailable.

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and bacterial pneumonia, although the pathophysiology of each entity is different.1 Data from Dr Foster's Guide and our local coding department revealed a high incidence and mortality from aspiration pneumonia alerting us to study those patients. Methods Retrospective analysis of 53 patients coded as aspiration pneumonia from February 2010 to March 2011. Analysis of presentation, investigations, management, pre-disposing factors and outcome was undertaken. Results Average Age 78, M/F ratio (1:1). Out of 53 coded as aspiration pneumonia, 2 were re-coded to an alternative diagnosis. Out of 51 patients, 36 died (71%) and 15 survived but 17/51 (23%) had chest xrays which were not suggestive of aspiration pneumonia. Of the 36 patients that died, 67% showed positive x-ray changes, while the 15 survivors had 80% x-rays suggesting pneumonia. Abstract S64 table 1 shows the list of clinical presentations and potential risk factors. On average each patient had 4 out of the 7 clinical features positive. 23/ 51 (45%) had either a basic swallow or SALT assessment of whom only 2/23 (9%) passed. 0/51 (0%) proceeded to mechanical ventilation. 51/51 (100%) had oxygen, intravenous fluids and antibiotics. Conclusion Aspiration pneumonia has a high mortality, particular in those with a history of aspiration living in residential or nursing facilities. 23% of patients with a good clinical history of aspiration did not show x-ray changes to suggest pneumonia. It may suggest a difference in the pathophysiology of lung injury in these patients who aspirate acidic gastric contents causing a chemical injury without xray changes of pneumonia. Although the treatment at present is no different, research needs to be incorporated into guidelines to diagnose, prevent and treat the different types of aspiration.