• P09.03: Prenatal diagnosis of trisomy 5p: a case report

      Kent, E.; Unterscheider, J.; Green, A.; Breathnach, F. (2010-10)
    • P24.03: Fetal anemia with normal Doppler velocimetry in the middle cerebral artery

      Kent, E.; Unterscheider, J.; Breathnach, F.; Daly, S.; Malone, F. D. (2010-10)
    • P25.02: Expectant management of pregnancies complicated by anencephaly

      Unterscheider, J.; Kent, E.; Burke, N.; Breathnach, F.; Malone, F. D. (2010-10)
    • P25.03: Perinatal management of meningomyelocele and encephalocele in a tertiary referral centre

      Unterscheider, J.; Kent, E.; Burke, N.; Wiig, U.; Breathnach, F.; Malone, F. D. (2010-10)
    • Paediatric cyclical Cushing's disease due to corticotroph cell hyperplasia.

      Noctor, E; Gupta, S; Brown, T; Farrell, M; Javadpour, M; Costigan, C; Agha, A (BioMed Central, 2015-06)
      Cushing's disease is very rare in the paediatric population. Although uncommon, corticotroph hyperplasia causing Cushing's syndrome has been described in the adult population, but appears to be extremely rare in children. Likewise, cyclical cortisol hypersecretion, while accounting for 15 % of adult cases of Cushing's disease, has only rarely been described in the paediatric population. Here, we describe a very rare case of a 13-year old boy with cyclical cortisol hypersecretion secondary to corticotroph cell hyperplasia.
    • Paediatric diagnostic reference levels in nuclear medicine imaging in Ireland.

      Gray, L; Torreggiani, W; O'Reilly, G (The British journal of radiology, 2008-11)
    • Paediatric early warning trigger, a cry for help

      Bolger, T; Clarke, N; Crowe, S; Martin, C; Koe, S (Irish Medical Journal, 2015-12)
      In paediatrics, it is crucial to ensure that the child who is clinically deteriorating is rapidly recognised and treated. We implemented a Paediatric Early Warning Trigger (PEWT) in our unit to improve recognition of these patients. Our trigger was a series of physiological measurements with a PEWT call if any result was outside the accepted range. We retrospectively compared 12 months prior to the introduction of the trigger (January to December 2009) to the three years post the introduction of the trigger (January 2010 to December 2012). We compared the time from deterioration to involvement of senior staff during the two time periods. We also examined the rates of crash calls and PICU transfers in the two periods. We found that the time from deterioration to senior clinician involvement reduced from 312 minutes to 166 minutes and the rate of transfers to PICU among the triage category 1&2 patients reduced from 1:50 in 2009 to 1:129, 1:118 and 1:131 during the three years of the trial. The rate of cardiac arrest among this group reduced from 1:100 in 2009 to 1:129, 1:216 and 1:542 during the three years of the trial. This study demonstrates the effectiveness of a Paediatric Early Warning Trigger in an Irish setting. We have been able to maximise senior clinician input into our sickest children in a more timely fashion.
    • A paediatric hernia with a twist: the presentation, imaging findings and management of a strangulated ovarian hernia

      Hughes, P; Abdelhafeez, A; Byrne, AT; Rea, D; JGillick, J (Irish Medical Journal, 2015-10)
      Indirect inguinal hernias are the most commonly encountered congenital abnormality in infants. 1,2 They may be complicated by herniation of abdominal or pelvic viscus. In girls, a herniated ovary is a relatively common finding, however torsion of the ovary is infrequent. A tender irreducible inguinal hernia in an infant girl should raise the possibility of a strangulated herniated ovary as it requires urgent surgical attention. When in doubt, ultrasound with colour Doppler easily confirms the diagnosis. Here we present the case of an ovarian inguinal hernia which had undergone torsion and review the presentation, imaging findings and management.
    • Paediatric HIV: The experience in Ireland 2004-2011

      Al-Assaf, N; O Maoldomhnaigh, C; Gavin, P; Butler, K (Irish Medical Journal (IMJ), 2013-07)
      Despite effective prevention strategies paediatric HIV infection remains an important condition in Ireland. To characterise presentation and identify barriers to optimal management a retrospective chart review of HIV-infected children presenting in Ireland, 2004-2011 was undertaken. Forty-two HIV-infected children were identified; (25 male). Median age at presentation was 6 years (range 0-16 years). 38 children (90%) were born to African mothers. Eleven (26%) were born in Ireland. Twenty-five (59%) were late diagnoses; 11 were symptomatic. Ten of 12 foreign born HIV-infected children had antiretroviral exposure with frequent resistance associated mutations. Seven of 8 children with stage C disease had previously been admitted to hospital in Ireland before diagnosis. Maternal non-adherence to recommendations and seroconversion in pregnancy challenge the goal of paediatric HIV eradication. Targeted strategies for women at risk of infection in pregnancy are required. Late HIV diagnosis remains common, highlighting the need for a more proactive approach to HIV testing.
    • Paediatric talus fracture.

      Byrne, Ann-Maria; Stephens, Michael; Department of Paediatric Orthopaedics, The Children's University Hospital, Temple Street, Dublin, Ireland. ann_maria_byrne@hotmail.com (2012)
      Paediatric talus fractures are rare injuries resulting from axial loading of the talus against the anterior tibia with the foot in dorsiflexion. Skeletally immature bone is less brittle, with higher elastic resistance than adult bone, thus the paediatric talus can sustain higher forces before fractures occur. However, displaced paediatric talus fractures and those associated with high-energy trauma have been associated with complications including avascular necrosis, arthrosis, delayed union, neurapraxia and the need for revision surgery. The authors present the rare case of a talar neck fracture in a skeletally immature young girl, initially missed on radiological review. However, clinical suspicion on the part of the emergency physician, repeat examination and further radiographic imaging revealed this rare paediatric injury.
    • Paediatric tonsillotomy: an Irish perspective on potential

      Fitzgerald, C; Oosthuizen, JC; Colreavy, M (Irish Medical Journal, 2015-04)
      Tonsillotomy is the preferred treatment of some otolaryngologists for younger patients (under 3 years) with low body weight (under 15kgs) and a history of obstructive sleep apnoea. The use of the technique in the same patient cohort for recurrent tonsillitis remains controversial. The aim of this study was to evaluate the indications and outcomes of paediatric patients undergoing tonsillotomy (with or without adenoidectomy) at a paediatric ENT centre in Ireland. Patients were identified from a prospectively maintained database and chart review was completed. A total of 23 patients were identified who underwent tonsillotomy. The commonest indication was Obstructive Sleep Apnoea (OSA) in 15 patients (65%). Outcomes following tonsillotomy compared favourably with traditional tonsillectomy. No intra-operative or post-operative complications were recorded (0%). No patients required readmission or later tonsillectomy (0%). At follow-up 19/23 patients with OSA (82.6%) had complete symptom resolution. Tonsillotomy appears to represent a safe, effective treatment option in the paediatric population, however, its role in recurrent tonsillitis remains controversial.
    • Paediatric type 1 diabetes in Ireland results of the first national audit

      Hawkes, CP; Murphy, NP (Irish Medical Journal, 2014)
      The aim of this study was to describe the services provided for children with type 1 diabetes in the Republic of Ireland, and to identify a baseline from which services and outcomes might be improved. Lead clinicians in 17 of the 19 centres providing paediatric type 1 diabetes care responded to requests for information from 2012 regarding demographics, patient numbers, diagnostics, outpatient management, multidisciplinary team resources, comorbidity screening, transition policy, clinical guidelines, and use of insulin pumps. The total number of patients attending these centres was 2518. Eight centres initiate insulin pump therapy. Insulin pump usage ranged from 0 to 42% of patients attending each centre. Self reported clinic mean haemoglobin A1c ranged from 8.2 to 9.4% (66.1 to 79.2 mmol/mol). Variation existed in guideline availability, frequency of clinic appointments, age of transition and insulin types used. We recommend a national approach to standardising and improving care for these patients.
    • Paediatric Type 2 Diabetes Still Rare in an Irish Tertiary Referral Unit

      Kernan, R; Carroll, A; Mc Grath, N; Mc Donnell, CM; Murphy, NP (Irish Medical Journal, 2018-01)
      While Type 2 Diabetes in childhood has become increasingly prevalent throughout the world, in our service we found that only 2% (7/320) of children and adolescents with diabetes aged < 16 years had type 2 diabetes. All type 2 subjects were overweight or obese and six of seven were non-Caucasian. Mean age at presentation was 12.8 years. Six patients (85%) had complications, most commonly hypertension. Although Type 2 Diabetes in children remains relatively rare in our cohort, identification of these children is important as management differs from Type 1 Diabetes.
    • Paediatricians' views on their role in the assessment and management of ADHD and autism.

      O'Keeffe, N; McNicholas, F (Irish Medical Journal (IMJ), 2011-10)
      ADHD and Autistic Spectrum Disorders (ASD) are a core component of paediatricians case work in the U.K. and U.S., but the situation in Ireland is less clear. Due to significant underdevelopment of Child and Adolescent Mental Health Services in Ireland, long waiting lists may delay identification and treatment. The aim of our study was to explore the views of a group of paediatricians in relation to their current and future practice of assessing and managing ADHD and ASD. The outcome of our study indicated that more than half of the paediatricians surveyed are directly involved in the assessment or treatment of ADHD and ASD. Eighty five per cent (85%) of paediatricians believed that they should have a role in the assessment of ADHD and ASD and over half had thought that they should be involved in managing ADHD and ASD. These results suggest that there is potential to develop alternative specialist services in Ireland for the identification and treatment of children with ADHD and ASD. The development of a well coordinated integrated care pathway may reduce waiting times for families and lead to easier access to services.
    • Pagets disease of bone: progress towards remission and prevention

      Healy, GM; Woods, C; Heffernan, E; McKenna, MJ (Irish Medical Journal, 2015-12)
    • A painful forefoot mass.

      Bolster, F; Griffin, J; McKenna, J; Kavanagh, E; Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland. (2013-04)