ABSTRACT
BACKGROUND All medical practitioners must be vigilant for child abuse and neglect (CAN) so that opportunities to intervene, prevent, and improve outcomes are not missed. However, child abuse is often overlooked in practice, and no sign or pattern of presentation of fractures is absolutely specific for child abuse. CASE REPORT Here, we present the case of a 22-month-old girl with progressive familial intrahepatic cholestasis (PFIC) type 2 who presented with "red flag" fractures indicative of child abuse. Biochemistry showed vitamin D deficiency and a skeletal survey revealed rickets and multiple pathological fractures. However, her age, number of differently-aged fractures and their circumstances, and differential diagnosis of CAN prompted adherence to joint Royal College of Radiologists and Royal College of Paediatrics and Child Health guidelines for non-accidental injury. CONCLUSIONS This case highlights some important considerations in management of suspected CAN in the context of the pathophysiology of a rare hereditary disorder that can result in pathological fractures.
Subject(s)
Cholestasis, Intrahepatic/complications , Fractures, Multiple/etiology , Fractures, Spontaneous/etiology , Rickets/diagnosis , Child Abuse/diagnosis , Diagnosis, Differential , Female , Humans , InfantSubject(s)
Bile , Intestinal Atresia/diagnosis , Intestinal Obstruction/diagnosis , Midwifery/methods , Vomiting/diagnosis , Diagnosis, Differential , Duodenum/abnormalities , Humans , Infant, Newborn , Intestinal Atresia/complications , Intestinal Obstruction/etiology , Referral and Consultation/statistics & numerical data , Vomiting/etiologyABSTRACT
Up to one in 10 neonates are investigated and treated for neonatal sepsis, although most are later found to be uninfected. This review discusses identifying and treating this emergency condition and how implementing NICE guidance could reduce treatment time in well babies and saveonatal sepsis resources without compromising care.
Subject(s)
Hospitals, District/standards , Infant, Newborn, Diseases/diagnosis , Infant, Newborn, Diseases/nursing , Intensive Care Units, Neonatal/standards , Sepsis/diagnosis , Sepsis/nursing , State Medicine/trends , Age of Onset , Female , Humans , Infant, Newborn , Male , Practice Guidelines as Topic , Risk Factors , United KingdomABSTRACT
A previously healthy 8-month-old boy presented to the emergency department with a 1-week history of chickenpox infection. His routine immunizations were up-to-date. His parents reported a high temperature (up to 39.5°C) in the preceding 48 hours and that he also had a mild cough, episodes of vomiting and loose stools. He had fed poorly in the 24 hours before presentation. Clinical assessment revealed a temperature of 36.7°C, heart rate 130/min, respiratory rate of 34/min and crusted chickenpox lesions. The infant was alert, smiling and playful, and systemic examination was otherwise unremarkable. He was admitted for monitoring of his fluid intake and temperature. As the infant continued to vomit intermittently in the 6 hours post admission, blood investigations were done and intravenous fluids were commenced. Laboratory investigations did not reveal biochemical evidence of dehydration, but they did show raised inflammatory markers: white blood cell count 24.8 × 109/litre, neutrophil count 19.8 × 109/litre and C-reactive protein 227mg/litre. In view of these results and the ongoing high fever, a chest X-ray was performed, revealing right upper lobe consolidation and collapse (Figure 1). Oral amoxicillin and flucloxacillin were started and oral feeding was successfully reestablished over the next 24 hours. He was discharged home after 48 hours, to complete a full 7-day course of oral antibiotics.
