World Congress on
Neonatology and Pediatrics

Dr Sofia Theodora Belitsi is a paediatric registrar, member of the Royal College of Paediatrics and Child Health(RCPCH). Has developed an interest in different areas of paediatarics and neonates after working in some of the biggest UK hospitals including Cambridge University hospital. Always keen to work with acute admissions and also inpatients covering a big range of paediatric pathology including tertiary neonatal care, oncology, neurology, gastroenterology, nephrology. Working close with paediatric surgical and neurosurgical colleagues in order to provide the best care for our paediatric patients. Being involved and also organizing teaching for medical students from Cambridge University and UCL.

6 year old boy presented in A&E in the first hours of the morning with ongoing generalised tonic clonic seizures and having not terminated with the benzodiazepines given by the paramedics. He had a recent 5 day history of reduced oral intake and being treated with Amoxicllin for a suspected ear infection. He has a backgound of developmental delay, four ferbile convulsions and hypermobility. His seizure management was escalated to Phenytoin infusion as per the protocol with incomplete resolution. In view of this and inefficient respiratory effort he was intubated for further ventilatory support and the seizure activity terminated at induction. An urgent unenhanced CT scan showed a 2 cm low attenuation mass in the right temporal lobe with a peripheral rim of higher attenuation and surrounding vasogenic oedema. A mild mass effect and opacification of the right mastoid was also noted. He received IV broad spectrum antibiotics and was treated as possible cerebral abscess or neoplasm. Had an MRI which showed 19x18x16mm peripherally enhancing mass with central restricted diffusion consistent with abscess of the right temporal lobe with peripheral oedema with mild uncal herniation. There was an associated epidural empyema overlying the inferolateral aspect of the temporal lobe with an apparent communication with the abscess. He had craniotomy and excision of the mass and six week course of broad spectrum intravenous antibiotics. A post excision CT scan is awaited. He is clinically well post procedure with no further seizures recorded. No growth reported from the abscess fluid cultures.

Anup Varghese Mathew is a member of the Royal colleges of paediatrics and child health, emergency medicine and college of surgeons ( MRCPCH, MRCEM, MRCS). He is completing his training as a general paediatrician with special interest in Paediatric Cardiology. He has published in reputed journals and serves a the co-director and the caldicott lead of the emergency doctors medical services.

Myocarditis is an inflammatory disease of the heart muscle caused by infection or chemicals. There is a wide spectrum of mortality and morbidity. No age, sex or racial predilection exists. Newborns, infants and immunosuppressed patients might be in higher risk. Case: 8 month old boy who was brought to A&E with paramedics from home with a 5 day history of fever, diarrhoea and reduced oral intake. On ambulance he was noted to be on VT. On arrival in A&E his airway was patent, his saturations were unrecordable, had chest movements, HR was around 140bt/min, CRT was 4seconds centrally . Face oxygen mask was applied and IV access was attempted but was unsuccessful so IO was inserted. Soon he went into PEA cardiac arrest. He was intubated, ventilated and chest compresssions were started. He received 5 doses of adrenaline in total, sodium bicarbonate, calcium chloride and had fluid resuscitation. Quick heart scan didn’t show any cardiac structural pathology. After 30min of full resuscitation the mutual decision between nursing, medical teams and the parents was made to withdraw care and patient died immediately. Ambulance ECG was reviewed and was noted patient to be in VT prior to arrival. Following this he was examined thoroughly and was noted to have Mongolian spots over the lower part of his body, lichenified eczema and had a 5 cm palpable liver. Rest of examination was unremarkable. Coroner’s report was suggesting a cause of death secondary to extensive myocarditis. Internal examination showed heavy, congested lungs and pleural effusions. Various viruses were detected in the blood (parechovirus), nose(parainfluenza,and enterovirus) and adenovirus in the liver tissue and nose. No virus detected on cardiac PCR. Had positive blood cultures for E.Coli. Genetic testing for channelopathies was sent and were negative.

Dr Sofia Theodora Belitsi is a paediatric registrar, member of the Royal College of Paediatrics and Child Health(RCPCH). Has developed an interest in different areas of paediatarics and neonates after working in some of the biggest UK hospitals including Cambridge University hospital. Always keen to work with acute admissions and also inpatients covering a big range of paediatric pathology including tertiary neonatal care, oncology, neurology, gastroenterology, nephrology. Working close with paediatric surgical and neurosurgical colleagues in order to provide the best care for our paediatric patients. Being involved and also organizing teaching for medical students from Cambridge University and UCL.

Neonatal jaundice is very common and in the majority of the cases is physiological. In some rare situation jaundice can be secondary to haemolysis, sepsis, Rh incompatibility, liver enzyme deficiency or anatomical liver and bile duct pathology. Non physiological jaundice is a neonatal emergency since patients tend to be haemodynamically unstable and in risk of brain injury. Case: Five day old girl, born at 39+3 weeks with a birth weight of 2.45kg, was referred by the community midwife to the acute paediatric services due to jaundice. No risk factors of infection in the perinatal period. On arrival she looked jaundice, had an SBR of 515micromol/L and she was started on triple phototherapy. At the same time she had blood tests done including FBC, clotting, liver and renal function tests, blood cultures, CRP, GAL-1-PU, ammonia, acylcarnitine, DAT, blood group T and was started on antibiotics and antiviral to cover for possible infection. She was on liver failure with deranged LFT’s and clotting function including INR: 4.6, PT: 53.8s, ALP: 1065u/l , lab uncong Bili :372 with congBili: 52 WCC: 11.6x 10^9/L. Was kept on intravenous 10% Dextrose, nil by mouth, had 3 doses of Vitamin K, 2doses of FFP and coagulation improved. When she was haemodynamically stable an urgent transfer was arranged to a paediatric liver unit hospital. While in the liver hospital she got a diagnosis of galactosaemia and further genetic testing was done which confirmed parents being carriers of the disease, confirming the autosomal recessive nature of the disease. There was no evidence of cataracts at her ophthalmology follow up. Currently she is on 4 hourly soy milk feeds and growing well with normal development.