Nebulization with B-agonist and administration of systemic corticosteroids are standard treatments for severe asthma exacerbations, but corticosteroids take several hours to become effective. IV magnesium sulphate (MgSO4) acts faster and has both antiinflammatory and bronchodilating properties. It appears to have played a pivotal role in the successful management of a child with severe asthma exacerbation and atelectasis unresponsive to conventional therapy. A literature review reveals that the results of IV MgSO4 are much greater in children than in adults, and can avoid the need to hospitalize 25% of children presenting with severe asthma. Magnesium sulphate appears safe to use.
Shock is a clinical challenge to neonatal intensivists and pediatricians alike. It occurs in critically ill babies for many reasons, but the main cause is sepsis that kills more than a million newborn globally every year. This article is designed to help young doctors and trainees have a better understanding of shock in the neonatal period and its management. The paper reviews the basic pathophysiology, risk factors, clinical investigation, management, supportive care, and complications in the common types of shock seen in neonates. Treatment is governed largely by the underlying cause, with the ultimate goal of achieving adequate tissue perfusion with delivery of oxygen and substrates to the cells, and removal of toxic metabolic waste products. Intervention needs to be anticipatory and urgent to prevent progression to uncompensated and irreversible shock respectively. Early recognition and urgent effective management are crucial to successful outcomes.
Urethral catheterisation is a common and safe procedure performed routinely. The small size of the urethra in a child necessitates the use of an infant feeding tube (Size 5 to 8 F) for catheterisation. Knotting within the bladder is a rare complication with significant morbidity often necessitating surgical or endoscopic removal. Insertion of an excessive length of tube contributes to coiling and knotting. We report an instance of knotting of an infant feeding tube in the proximal penile urethra of a 4 year-old male child requiring urethrotomy to remove it. Awareness of the risk and proper technique can reduce this complication.