A term infant presented at birth with bilious vomiting and abdominal distension. Multiple investigations were undertaken, including two laparotomies and a rectal biopsy, as no obvious cause for his symptoms could be found. This included testing for human cytomegalovirus (CMV) infection as part of a TORCH screen, which was negative at 10 days of age. However, a repeat screen at 3 weeks of age demonstrated positive findings of CMV in both urine and blood PCR. This subsequently led to the diagnosis of gastrointestinal pseudoobstruction associated with perinatal CMV infection. This case is of interest though there is limited information regarding the recognition of gastrointestinal symptoms in relation to CMV infection. This report aims to highlight our experience with an infant with perinatal CMV infection and severe gastrointestinal symptoms.

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Background and aims Prolonged neonatal jaundice is a common presentation in newborns and rarely requires intervention; however it is important to rule out sinister causes such as biliary atresia. The outcome of this study was to analyse the demographics of infants presenting with prolonged jaundice, investigations undertaken and results of these tests in relation to NICE guidelines. Methods We retrospectively identified infants over 2 years (January 2012 to December 2013) coded to have a prolonged jaundice screen. Analysing the case notes, 90 infants had a screen performed, from age 14 to 71 days of life, with an average of 21 days of life. Results Of the infants screened, 18 (20%) patients were found to have abnormal initial results, with significant abnormalities in 3 (3.3%) patients. One infant who presented at day 71 of life was identified to have biliary atresia, one infant had a urinary tract infection, and one infant had a positive reducing sugar and confirmed to be lactose intolerant. Four patients had ABO incompatibility but were otherwise well. Conclusion In our study, we found only one baby with conjugated hyperbilirubinaemia who presented late. The remainder of the babies investigated for prolonged jaundice were benign. Majority of the infants (72%) were breastfed, which is a well-recognised cause for prolonged jaundice. As such, the authors propose that in well babies with pigmented stools, performing the prolonged jaundice screen at 21 rather than 14 days could reduce the burden of carrying out unnecessary tests without causing significant detriment to these patients.

Kawasaki disease (KD) is an acute febrile illness, principally affecting children under 5 years, due to a systemic vasculitis of obscure etiology. In 2017, the American Heart Association published the diagnostic criteria for KD in their scientific statement. Following the emergence of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there has been an upsurge in the reports of KD as well as a novel multisystem inflammatory syndrome in children (MIS-C). Clinical manifestations of MIS-C are similar to KD and toxic-shock syndrome, making the clinical diagnosis challenging. Studies have shown promising results to differentiate KD from MIS-C using epidemiological, clinical, hematological, and immunological characteristics. Serological evidence may be negative in these patients at presentation, as MIS-C is a late manifestation of SARS-CoV-2 exposure. However, diagnosis and management challenges currently exist due to a gap in knowledge of these conditions. Further research is warranted to identify diagnostic tools to differentiate KD and MIS-C and optimize the therapeutic strategy, reducing morbidity and mortality related to these phenotypically similar diseases. This review aims to highlight the best available evidence for managing children with KD and MIS-C in the background of the ongoing COVID-19 pandemic.