Performing a split bilirubin test to identify liver disease in any infant who remains jaundiced beyond 2 weeks of age has been recognised as good clinical practice. The Leeds Community Midwifery Team performed this test, following an agreed protocol, from December 2000. By February 2008, 882 infants had been tested. Three infants were identified as having significant liver disease, including one with biliary atresia. Examining the liver unit database, a further 38 infants with Leeds post codes presented with neonatal liver disease during the study period. Five infants were identified appropriately by the midwives but not reported via the study protocol, 29 were referred from secondary care, (1) by a general practitioner at 9 days of age and (2) who did not become jaundiced before 3 months, leaving one infant who was 'missed' by the midwives. No infant whose conjugated bilirubin was below the authors' threshold later presented with liver disease. This is an effective protocol for identifying neonatal liver disease but requires ongoing education to maintain compliance.

No abstract

AimTo investigate the outcome after surgery in children with inflammatory bowel disease (IBD).MethodCase notes of patients who had surgery for IBD between November 1999 and January 2011 at a tertiary hospital in the UK were reviewed. Data related to relapses, acute readmissions, weights and heights one year before and up to a maximum of three years after surgery were collected. Mean Standard Deviation scores (SDS) were calculated for weights and heights. Outcomes were analysed using the paired t test.Results38 patients were eligible for the study. Of these case notes were available for 31 patients. 61% (n=19) had Crohn’s Disease (CD) and 39% (n=12) had Ulcerative Colitis (UC). The commonest indication for surgery was failure of medical management (48%). Surgical interventions included subtotal colectomy with ileostomy (18), extended right hemicolectomy (11), total colectomy (1) and limited ileal resection (1).74% (n=14) of CD patients had no relapses in the follow up period after surgery. The average number of relapses (in 12 patients for whom data was available) came down from 2.3 in the year before surgery to 0.4 in year after surgery with a mean reduction of 1.9 (p=0.0001; 95% CI: 1.2 to 2.7). There was no statistically significant difference in the average number of acute readmissions between these periods. At one year after surgery the increase in mean SDS was 0.78 (p=0.01 CI: 0.2 to 1.3) for weight and 0.3 (p=0.002; CI: 0.13 to 0.46) for height.UC does not recur after total proctocolectomy. Hence there were no relapses after surgery. In the six patients for whom data was available, there was an insignificant increase in the average number of hospital admissions from 1 in the year before surgery to 1.5 in the year after (mean increase 0.5; 95% CI: 1 to 2; p=0.45). At one year after surgery the change in mean SDS was −0.1 (p=0.5; CI: −0.4 to 0.2) for weight and 0.18 (p=0.07; CI: −0.02 to 0.4) for height.ConclusionsThere was improvement in growth and reduction in number of relapses after surgery in CD patients. For UC patients no significant improvement was seen either in terms of readmissions or growth

Intussusception is the most common abdominal emergency in children younger than 2 years of age. A 6-month-old child presented as dengue with gross abdominal distension to our hospital. Dengue was managed using standard therapy as per world health organization protocol, while abdominal pathology, later found out to be intussusception, required exploratory laprotomy. At the outset, abdominal distensions in the setting of a severe dengue infection, could be misdiagnosed as ascites due to capillary leakage, masking the clinical findings of acute abdomen on examination.  Although unusual, it is possible to find two concurrent illnesses simultaneously, one complicating the typical clinical course expected from the other, and this needs high index of suspicion due to different management strategies of both. We describe here the diagnostic dilemma of such a case.