Poisoning by Polyethylene Glycol – An Adjuvant for Insecticides.

Background: Accidental poisoning in children with surfactant used as an agriculture adjuvant is uncommon Case characteristics: A 7-month-old girl presented with severe respiratory distress 48 hours following ingestion of surfactant, and required intubation and mechanical ventilation. Outcome: The child was successfully managed with supportive therapy. Message: Poisoning by polyethylene glycol can be severe and life-threatening.

Hyperinsulinemic Hypoglycemia in Infancy: Current Concepts in Diagnosis and Management.

Purpose: Molecular basis of various forms of hyperinsulinemic hypoglycemia, involving defects in key genes regulating insulin secretion, are being increasingly reported. However, the management of medically unresponsive hyperinsulinism still remains a challenge as current facilities for genetic diagnosis and appropriate imaging are limited only to very few centers in the world. We aim to provide an overview of spectrum of clinical presentation, diagnosis and management of hyperinsulinism. Methods: We searched the Cochrane library, MEDLINE and EMBASE databases, and reference lists of identified studies. Conclusions: Analysis of blood samples, collected at the time of hypoglycemic episodes, for intermediary metabolites and hormones is critical for diagnosis and treatment. Increased awareness among clinicians about infants “at-risk” of hypoglycemia, and recent advances in genetic diagnosis have made remarkable contribution to the diagnosis and management of hyperinsulinism. Newer drugs like lanreotide (long acting somatostatin analogue) and sirolimus (mammalian target of rapamycin (mTOR) inhibitor) appears promising as patients with diffuse disease can be treated successfully without subtotal pancreatectomy, minimizing the long-term sequelae of diabetes and pancreatic insufficiency. Newer insights in understanding the molecular and histological basis and improvements in imaging and surgical techniques will modify the approach to patients with congenital hyperinsulinism.

Ex-utero Intrapartum Treatment (EXIT) Procedure for Giant Fetal Epignathus.

Background: Large fetal oropharyngeal tumors are rare, and have the potential to cause airway obstruction during birth. Case characteristics: A 35-year-old woman with antenatally diagnosed large heterogenous mass in fetal neck displacing trachea and filling up the orophanygeal space. Intervention: The infant was delivered at 31 weeks of gestation by ex-utero intrapartum therapy procedure to secure the airway. Outcome: Tumor was resected successfully on day 8 of life. Histopathology revealed mixed teratoma. Message: Ex-utero intrapartum therapy for fetuses with severe upper airway compromise may prove life-saving.