No abstract

Background Meconium aspiration syndrome remains a condition still encountered in the neonatal intensive care units resulting in significant morbidity and mortality among term neonates. With advances in neonatal intensive care management, the outcomes of babies with meconium aspiration syndrome have improved significantly. These include the use of high frequency ventilation with inhaled nitric oxide. This has significantly reduced the need to send these babies for extracorporeal membrane oxygenation (ECMO) treatment. Aims To review the management and outcomes of babies ventilated for meconium aspiration syndrome in a tertiary neonatal intensive care unit (NICU). Methods We retrospectively searched the Badger electronic patient record for all babies with a diagnosis of meconium aspiration syndrome in the last 9 years between 01/01/2010 and 31/12/18. We then selected all ventilated babies with meconium aspiration syndrome for this review. A structured excel spread sheet was used to collate and analyse the data. Results In the last 9 years there were 77 ventilated babies who had a diagnosis of meconium aspiration syndrome assigned to their badger electronic patient record. 59 were inborn and 18 were outborn babies. The median gestation age was 40 weeks with a range between 35 and 42 weeks. The median birth weight was 3470 grams with a range between 1836 grams and 4850 grams. 47 babies were managed with conventional ventilation and 30 babies were on high frequency ventilation. 38 babies received surfactant as part of their treatment for meconium aspiration syndrome. 37 babies also received inhaled nitric oxide. 43 babies had inotropic support. 3 babies had ECMO. One was an inborn baby referred for ECMO in 2014. The other two were out-born babies transferred back to the NICU following ECMO for on-going management. All 3 babies who went for ECMO were discharged home. 2 babies died in the last 9 years (2014 and 2015) but these were attributed to their neurological conditions. Conclusion The outcomes of babies ventilated for meconium aspiration syndrome are good despite the serious nature of the disease. Swift escalation of the management of persistent pulmonary hypertension of the newborn (PPHN) is the key to reducing morbidity and mortality. With advances in the management of PPHN, we had only referred one inborn baby for ECMO in the last 9 years for meconium aspiration syndrome. The results of this review provide guidance when counselling these traumatised parents of babies ventilated for meconium aspiration syndrome.Introduction Orkambi (Lumacaftor/Ivacaftor) was first introduced for use in the Cystic Fibrosis population in Ireland in 2017. It is only licensed for those patients who are homozygous for the F508del gene mutation.Orkambi was originally approved for children aged 12 years and older in 2017 and then this was extended for those aged 6-11 years old in 2018. Recently, the EMA(European Medicines Agency) has approved use for children 2-5 years. CUH(Cork University Hospital) looks after 98 paediatric patients wi...

Background Recurrent otitis media is one of the common infections of childhood. The causative bacterial pathogen is one of the major risk factors of recurrent infection. With limited availability of Indian data, we performed this study to identify the bacterial pathogens. Materials and Methods Otitis media cases were diagnosed based on clinical criteria. Thirty-six middle ear fluid (MEF) samples were collected by tympanocentesis and cultured for pathogens. Seventy-eight per cent of the cases had three previous episodes of otitis media in the past 6 months; the remaining 22% had four episodes in the preceding 6 months. At the time of sample collection, all patients were on antibiotic coverage. Genomic DNA was extracted from MEF samples using Qiagen DNA mini Kit. The 16s rDNA polymerase chain reaction (PCR) and quantitative multiplex (qmPCR) for Streptococcus pneumoniae was performed on these samples. Streptococcus pneumoniae–positive samples were serotyped using PCRSeqTyping. Results None of the 36 samples showed growth by conventional culture. The 16s rDNA PCR identified bacterial pathogens in 33 samples. Four samples gave mixed reads. The organisms identified were Neisseria spp. other than Neisseria meningitidis (n = 7), N. meningitidis (n = 8), Lactococcus spp. (n = 5), S. pneumoniae (n = 2), Pseudomonas aeruginosa (n = 2), Haemophilus influenzae (n = 1), Salmonella infantis (n = 1), Staphylococcus epidermidis (n = 1), Staphylococcus auricularis (n = 1), and Streptococcus sp. (n = 1). The qmPCR detected the presence of S. pneumoniae in six samples. PCRSeqTyping was able to identify Serotype 19A in two samples positive for S. pneumoniae. Conclusion The study demonstrates the usefulness of 16s rDNA PCR protocol to identify the bacterial pathogens in MEF by a culture-independent method. Neisseria spp. were the predominant species identified followed by Lactococcus spp. and S. pneumoniae. Detection of pneumococci by 16s rDNA PCR correlated well with qmPCR-based detection and PCRSeqTyping.