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Background and aims Childhood accidents are the leading cause of health problems, death and disability that can be prevented. Accidents can be predicted and avoided by identifying the risks. The aim of this study is to investigate the characteristics of paediatric forensic cases and to reveal the relationship between judicial decisions and trauma scores. Methods Forensic reports of the Children under 18 admitted to our emergency department of Van Military Hospital, a second level hospital, between January and November 2013 were retrospectively evaluated. Demographic data of the patients and life threat decisions were investigated and trauma scores were calculated. P-value under 0,05 was considered to be significant. Results Forty-four (15.1%) of 290 forensic cases admitted to our emergency department were under 18. Of the patients, 43.2% (19) were female and the mean age was 8.7 ± 5.41 (minmax: 0-17). Ten (22.7%) of them were traffic accident, 8 (18.2%) were falling from height, 12 (27.3%) were assault, 2 (4.5%) were burn, 10 (22.7%) were poisoning and suicide. Four of all patients (9.1%) were having life threat and 9 (20.5%) patients were having no injury requiring simple medical intervention. In the evaluation of the cases; Injury Severity Score (ISS) was 1.93 ± 2.27 (1-16), Revised Trauma Score (RTS) was 99.72 ± 0.17 (99-99.83), Trauma score-injury severity score (TRISS) was 7,082 ± 0.15 (7,841) and New Injury Severity Score (NITS) was 2.55 ± 3.52 (1-16). Conclusions Traffic accidents, falls, assaults and poisonings are the most common forensic cases in childhood and we found a significant relationship between life threat decision and anatomical and physiological trauma scores.

Purpose To evaluate the diagnostic performance and safety of intravesical administration of a-second-generation ultrasound contrast-agent (UCA) for the diagnosis of vesicoureteric reflux (VUR) in children. Methods and materials 1350 children (587 boys/763 girls, mean-age 2.6y, range 15d-17y) with 2720 pelvi-ureter-units, underwent contrast-enhanced voiding urosonography (ceVUS) to rule out VUR and urethral pathology. A second-generation UCA (SonoVue ® , Bracco, Milan) was administered intravesically through 5-8F feeding-tube at a dose of 0.5 ml/bladder filling. Possible adverse-events were monitored during the examination and followed-up for 7 days after the ceVUS by phone-calls. Urine analysis and culture were performed 3-5 d before ceVUS in all children and 24-48 h in any patient reported with adverse-events. Results VUR was detected in 450/1350(33%) patients (162 boys/288 girls). This was in 653 pelvi-ureter-units (reflux-grade distribution: grade I = 1, grade II = 276, grade III = 266, grade IV = 100, grade V = 10). The urethra was normal in all children. Mean duration of examination was 14 ± 7 min, including urethral imaging. Minor adverse-events were reported in 45 (3.3%) children. These included dysuria (n = 39), abdominal pain (n = 2), increased frequency of micturition (n = 1), vomiting (n = 1), perineal irritation (n = 1), and urinary-tract-infection after ceVUS (n = 1). The onset of adverse-events were subacute in 92% and delayed in 8% and were self-limited nonrequiring hospitalisation. Conclusions There were no serious adverse-events with intravesical use of SonoVue ® . Only a few minor adverse-events were reported during ceVUS most likely due to catheterization process. Thus ceVUS with intravesical administration of a second generation UCA (SonoVue ® ) for VUR and urethral pathology detection is a safe and reliable diagnostic procedure in children. Background Idiopathic Hypercalciuria (IH) has been associated with decreased bone density up to 30% of the children. Aims To determine the concentrations of cytokines osteoprotegerin (OPG) and sRANKL and other biochemical indices of bone metabolism in children with IH. Methods In 31 children of median age 6.3 years (range 2.2-16.4) with IH OPG, sRANKL, 25(OH)D, 1,25(OH) 2 D, PTH, Ca, Pi, osteocalcin, ALP and CTx-Crosslaps were determined in serum and Ca/Cr, oxalate/Cr and citrate/Cr in urine. Times of study were at diagnosis and after 3 months of salt free and adequate Ca diet. Height and BMI z-score were assessed. Clinically healthy children (n = 35) matched for age/sex and season were used as controls (median 7.8 years, range 1.8-16.3). Results Although urinary Ca excretion (24 hCa and UCa/UCr) decreased at 3 mo (p < 0.05 and p < 0.01) on average it had not reached control values (p < 0.0001, p = 0.0004). No significant differences were found for urine excretion of citrate and oxalate or for serum Ca, Pi, 25OHD, 1,25(OH) 2 D, PTH, osteocalcin, ALP, OPG, sRANKL and sRANKL/OPG ratio in patients before and after diet or compared to controls. Only serum co...

Background and aims If infants fail to initiate spontaneous breathing after birth, international guidelines recommend positive pressure ventilation (PPV). However, mask PPV remains challenging with leakage occurring commonly. Despite a variety of available facemasks, none has been systemically studied in newborn infants. We aimed to determine if using a Fisher and Paykel (FP) round facemask would reduce mask leak compared to using a Laerdal round facemask during mask PPV in preterm infants.Methods From April to September 2013, at the Royal Alexandra Hospital, newborn infants. Results Fifty-eight preterm infants (n = 29 in each group) were enrolled; mean±SD gestation 28 ± 3 weeks; birth weight 1210 ± 448 g, 30(52%) male, 39(67%) born by caesarean section. Apgar scores at 1 and 5 min were 5 ± 3 and 7 ± 2, respectively. Infants randomised to the FP facemask and Laerdal facemask had similar mask leak (37 ± 17% vs. 33 ± 12%, respectively, p = 0.30) and tidal volume (7.3 ± 3.0 mL/kg vs. 6.9 ± 2.7 mL/ kg, p = 0.73) during PPV. There were no significant differences in ventilation rate, inflation time or airway pressures between groups. Conclusions The use of either facemask during PPV in the delivery room yields similar mask leak. Background and aims Endotracheal intubation is a mandatory skill for neonatal trainees. However, inexperienced trainees have success rates <50%. We compared intubations supervised by an instructor watching a videolaryngoscope screen with the traditional method where the instructor does not have this view. Methods RCT (ANZCTR# 12613000159752) at The Royal Women's Hospital, Melbourne. Eligible intubations were those performed orally, in infants without facial or airway anomalies, in the delivery room or in NICU, by trainees with <6 months experience. Intubations were randomised to videolaryngoscope screen visible to the instructor (intervention) or covered (control). Primary outcome was first attempt intubation success rate confirmed by colorimetric detection of expired CO 2 . A sample size of 206 provided 80% power to detect a 20% difference in success rates (50% vs. 70%). Background Continuous Renal Replacement Therapies (CRRT) are the treatment of choice for critically ill children with Acute Renal Injury. Hypotension after starting CRRT is frequent but there are no studies that have analysed their incidence and importance. Patients and methods A prospective, observational study was performed including critically ill children treated with CRRT between October 2009 and December 2013. Hemodynamic data and connection characteristics were collected before, during and 60 min after CRRT circuit connection. Hypotension with the connection was defined as a decrease in mean arterial pressure >20% from baseline and/or intravenous fluid expansion and/or if increase in vasopressors was required. Results 161 connections in 36 children (median age 18.8 months) were analysed. 28 patients (77.8%) were in the postoperative period of cardiac surgery, 94% on mechanical ventilation and 86.1% with vasopressors. T...

Backgrounds and aims Wood Downes's modified by Ferres score (WDF) was not designed for the bronchiolitis, but its use has been generalised to evaluate the severity. Our aim is to relate the length of stay and the bronchiolitis´s severity at admission, by WDF. Patient and methods We included the acute bronchiolitis hospitalised during two epidemics (2011)(2012)(2013). They were classified in mild (MiB; WDF <4), moderated (MB; WDF 4-7) or severe (SB; WDF > 7) according to the scale WDF realised at admission. The mild ones and to the patients without WDF at admission were excluded. The main variable was the length of stay. We registered: age, RSV, sex, previous and during treatment and UCIP's need. Analysis with SPSS 17.0. Results 208 hospitalised infants were included (mean age of 72,9 days (5-373). Positive RSV in 67,8%. 90,5% were MB and 9,5% SB. Both groups were homogeneous in demographics data and previous admission treatment (p > 0.05). The mean WDF at admission was 5,42 (4-10). During the hospitalisation, they received nebulised bronchodilator in 3% hypertonic saline solution (3%SSH) (65%) or 3%SSH (35%). 22% received corticoids and 8,2% antibiotics. Length of stay: 5,3 days (0-46). The MB had an mean length of stay of 4,8 days and the SB of 13,44 (p = 0.0001). Conclusions WDF's scale has demonstrated, in our sample, to be a good predictor of the length of stay in moderate and severe bronchiolitis. The SB had a statistically significant more length of stay than MB.