<b><i>Background:</i></b> Congenital diaphragmatic hernia (CDH) often presents with severe cardio-respiratory impairment in the neonatal period. Affected infants may be exposed to multiple nephrotoxic insults, predisposing them to acute kidney injury (AKI). The prevalence of AKI in a CDH cohort has not previously been described. <b><i>Objectives:</i></b> The primary aim of this study was to quantify the prevalence of AKI in patients with CDH treated in a single national centre. Secondarily, we investigated the association between AKI, select neonatal outcomes, and recognised AKI risk factors. <b><i>Methods:</i></b> This was a retrospective analysis of all patients with CDH treated at our regional neonatal surgical centre between September 2011 and December 2017. Data was collected on demographics, CDH Study Group stage (size), laboratory and physiological parameters, medications, mortality, and duration of hospitalisation. AKI severity was stratified using the modified paediatric RIFLE criteria, determined by comparing the percentage increase in serum creatinine from baseline. Statistical analysis was performed using Fisher’s exact and Pearson’s χ² tests for parametric analysis and Mann-Whitney U testing for non-parametric analysis. <b><i>Results:</i></b> Fifty-four CDH patients met the inclusion criteria, 37% of whom developed AKI. The development of AKI was significantly associated with larger CDH defect (type C/D; <i>p</i> = 0.014), extracorporeal membranous oxygenation support (<i>p</i> = 0.003), patch repair (<i>p</i> = 0.004), and exposure to vancomycin, corticosteroids and diuretics (<i>p</i> = 0.004, <i>p</i> = 0.007, and <i>p</i> ≤ 0.001, respectively). There was no statistical association between AKI and gentamicin administration, umbilical arterial catheter insertion, or significant infection. Prolonged hospitalisation and patient mortality were significantly associated with AKI (<i>p</i> = 0.01 and <i>p</i> = 0.001, respectively). <b><i>Conclusions:</i></b> AKI is common in CDH cases treated in our centre and is associated with adverse outcomes. Potentially modifiable risk factors include nephrotoxic medication exposure. Prevention and early recognition of contributory factors for AKI may improve outcomes in CDH.

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Vagal reflexes have been well documented in both human and veterinary anaesthetic literature. A trigeminocardiac reflex (TCR) is a vagal reflex frequently documented in human medicine, and subtypes such as the oculocardiac reflex (OCR) are well documented in veterinary medicine throughout numerous species. 1-3 A further TCR subtype, the maxillomandibulocardiac reflex (MCR) has been documented in human literature associated with facial fractures and has recently been described in a sole case report in a dog. 4 Thus far, it has not been documented in a horse. The current case report aims to describe the perianaesthetic management of a horse that developed asystole due to a suspected TCR of either OCR or MCR in origin, in combination with hyperkalaemia of unknown cause which may or may not have contributed to the suspected vagal event, a relationship that has been previously documented. 5,6 Both causes will be discussed as independent or contributory factors.

This retrospective case series describes clinicopathological data and outcome of hospitalised atypical myopathy (AM) cases in the South-East of England. The study aimed to describe the frequency of metabolic abnormalities (hyperglycaemia, hyperlactataemia, hypertriglyceridaemia) and outcome in AM cases in the South East of England and test the hypothesis that serum creatine kinase (CK) activity and blood glucose, lactate and triglyceride concentrations are associated with outcome. Medical records (2011-2017) from 3 referral hospitals were reviewed for cases with a clinical diagnosis of AM. A previously described algorithm was applied and cases were included if a diagnosis of AM was considered highly likely. In cases admitted after 2013 known or possible exposure to sycamore trees was also required for inclusion. Sixty-four animals were included, 44% (28/64) survived. Hyperglycaemia, hyperlactataemia and hypertriglyceridaemia were present in 76%, 89% and 92% of horses on admission, respectively. Survivors had lower blood lactate concentrations

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