E mergency physicians face challenging diagnosis and management of infants presenting with acute fever and bulging fontanelle from time to time. We have recently managed a previously healthy infant presenting to the emergency department with acute-onset high fever, bulging fontanelle, and tachycardia with prompt meningitic dosage of intravenous ceftriaxone after a thorough clinical assessment and obtaining a peripheral blood culture. Cerebrospinal lumbar fluid (CSF) pleocytosis and very high C-reactive protein (CRP) were present. The infant recovered well despite negative blood and CSF culture and extensive viral investigations. Several management issues are encountered. We performed a literature review to address these issues.

Chylothorax is a known complication of postcardiac surgery and the most common cause of pleural effusion in neonates. Conservative management is usually adopted, including Nil‐per‐Oral (NPO), treatment of underlying etiology of infection, and use of octreotide. Chylothorax resistant to medical therapy and drainage is often treated by chemical pleurodesis. Previously used pleurodesis agents have included talc, minocycline, OK‐432, bleomycin, and povidone‐iodine. 50% Dextrose (D50) has been reported to be useful for pleurodesis in adults. We successfully managed two cases of prematurely born infants with D50 as an alternative chemical sclerosant for chemical pleurodesis in a resistant chylothorax and discussed evidence of its use in the literature

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Introduction Spinal muscular atrophy is a congenital condition associated with mutations in the SMN1 gene. Patients have normal intellectual development, but the natural history is progressive respiratory failure resulting in premature death. Case Diagnosed with spinal muscular atrophy type 2 in early primary school, the wheelchair‐bound girl developed severe pneumonia on one occasion, when she became critically ill and was admitted to the paediatric intensive care unit with multiorgan dysfunction, requiring mechanical ventilation and high inotropic support. Parents and the patient expressed strong desire for full respiratory and intensive care support to be given. Survived the episode, she is wheelchair ambulatory and continues to pursue a creative artistic career. Discussion Children with SMA and their families need to be supported by a comprehensive multi‐disciplinary team to manage this illness. Pediatricians and healthcare givers must provide up‐to‐date health advice on COVID‐19 prophylaxis and management to special groups of patients with respiratory and neurological risks.