『Two Paeds In A Pod』のカバーアート

Two Paeds In A Pod

Two Paeds In A Pod

著者： Dr Ian Lewins
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2 Paeds in a Pod is a clinical paediatrics podcast exploring the decisions, dilemmas, and systems that shape everyday practice. While rooted in paediatric emergency medicine, the conversations range across the breadth of paediatrics — from acute presentations and diagnostic uncertainty to wider service design, professional development, and the evolving evidence base. Each episode brings structured discussion to real-world clinical questions. Alongside practical case-based reflection, we highlight research that has caught our eye and consider how emerging evidence should — or should not — influence frontline care. This podcast is for paediatric consultants, trainees, advanced practitioners, and clinicians who want thoughtful, evidence-aware conversation grounded in the realities of modern practice. This podcast is for medical education purposes only and should not replace advice you have received from a medical practitioner.All rights reserved 科学 衛生・健康的な生活 身体的病い・疾患
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  • Episode 86: Mental Health Crisis on the Wards

    Episode 86: Mental Health Crisis on the Wards
    2026/06/21
    EPISODE SUMMARYThis episode leads on a problem every acute paediatric unit now lives with: the child in mental health crisis admitted to a general children's ward while waiting for specialist care. A new UK consensus study sets out sixteen practical, risk-stratified strategies that a non-specialist team can use to keep these young people safer. The second story turns to the forearm fracture, with a large cohort showing that one child in eight returns to the emergency department within a week of casting — rising to one in four for reduced distal both-bone fractures — and a companion piece asking whether ultrasound can guide the reduction itself. What's Caught My Eye covers whether "highly toxic" drugs really threaten toddlers after a single dose, real-world evidence that earlier egg introduction cut egg allergy, and the refreshed top ten research priorities for paediatric emergency medicine across the UK and Ireland.━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━MAIN STORY 1: Keeping children in mental health crisis safe on the ward━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━Children and young people in mental health crisis are routinely admitted to acute paediatric wards that were never designed to hold them, cared for by staff with little mental health training. This UK mixed-methods study asked a deliberately practical question: while these young people are in our care, what can a general team actually do to reduce risk?Key findings:Twenty-six candidate risk-mitigation strategies were generated from a systematic review and qualitative interviews.Sixteen reached expert consensus (≥70% agreement) for clinical usefulness among a panel of 16 healthcare professionals and experts by experience.Prioritised strategies included structured safety checks on admission and daily thereafter, proactive environmental modification to remove triggers and ligature risks, one-to-one observation reframed around therapeutic engagement rather than surveillance, timely escalation to specialist mental health services, and routine multidisciplinary safety huddles.Each strategy was mapped to clinical risk level (low, medium, high, very high) using a validated paediatric mental health risk assessment framework.For practice, this converts a familiar sense of helplessness into a structured, risk-matched checklist that any acute paediatric team in the NHS can adopt immediately, without waiting for system-level reform.The caveat: these are consensus-derived strategies from a small expert panel, not outcomes from a trial, so this is a framework for good practice rather than proof of reduced harm — and escalation to specialist services remains part of it, not an alternative to it.Reference: Kaltsa A, Marufu TC, Carter T, et al. Archives of Disease in Childhood. Published May 2026.DOI: https://doi.org/10.1136/archdischild-2025-328977━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━MAIN STORY 2: Forearm fractures — life after the cast, and guiding the reduction━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━The forearm fracture is everyday work in paediatric emergency medicine, but we rarely track what happens once the child leaves with a cast. This single-centre cohort quantified unplanned return visits within the first week, and a companion Archives piece asks whether point-of-care ultrasound could improve the reduction at the bedside.Key findings:Among 551 children treated with circumferential casting (from 4,661 forearm fractures reviewed), 67 (12.2%) made an unplanned return to the ED within seven days.92.5% of returns were for pain and around 95% required cast modification.Return rates varied sharply by pattern: distal radius and ulna 23.8%, midshaft both-bone 15.7%, distal radius alone 8.5%, other 5.5%.Returns were more than three times as likely after reduction than after in-situ casting (16.1% vs 4.3%), peaking at 27.1% for reduced distal both-bone fractures.There were no cases of compartment syndrome and 98.4% completed non-operative treatment successfully.The clinical bottom line is about specific, risk-matched safety-netting: a reduced distal both-bone fracture carries a one-in-four chance of a painful early return, so families with high-risk patterns need tailored expectations and follow-up rather than a generic discharge.This is single-centre data from outside the UK, so absolute rates will differ here, but the pattern — reduced wrist fractures being the ones that bounce back — will be familiar to any UK ED or fracture clinic, and the ultrasound question speaks to whether a better first-time reduction could cut returns at source.Reference: Romem R, Aliev E, Fainzack A, et al. Pediatric Emergency Care. Published June 2026....
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    16 分
  • Episode 85: The Trouble With Boluses

    Episode 85: The Trouble With Boluses
    2026/06/07
    2 PAEDS IN A POD Episode 85 | The Trouble With BolusesReleased: 07/06/2026 | Runtime: ~20 minutesEPISODE SUMMARYThis episode leads on fluid in childhood sepsis. A new multicentre cohort from Australia and New Zealand found that mortality rose with the volume of bolus fluid given in the first day, but not with the total volume of fluid — a finding set alongside the recently published PRoMPT BOLUS trial, which showed that balanced fluid and saline produce the same kidney outcomes. The second story returns to the febrile infant for a third time, with a meta-analysis quantifying the risk of serious bacterial infection in the well sixty-to-ninety-day-old. What's Caught My Eye covers the TWIST score and ultrasound for the acute scrotum, nirsevimab versus the maternal RSV vaccine head to head, and language barriers and safety in the paediatric emergency department.━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━MAIN STORY 1: How much fluid is too much in childhood sepsis? ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━Fluid is the first thing we reach for in the septic child, and the volume question has never been fully settled. This cohort measured the fluid children actually received in the first twenty-four hours and asked how it related to outcome, arriving just as PRoMPT BOLUS reported on the separate question of which fluid to use.Key findings:5,352 children with suspected community-acquired sepsis across 11 emergency departments in Australia and New Zealand (2021–2023); median age 2.6 years.In-hospital mortality was low at 1.1%; around 5.5% met Phoenix sepsis criteria.Median total fluid in the first 24 hours was 40 mL/kg, of which the bolus component was 10 mL/kg.Mortality rose with increasing bolus volume but not with increasing total fluid; the unadjusted odds ratio for death with more than 55 mL/kg versus less than 15 mL/kg of bolus fluid was 20.5 (95% CI 8.0–52.5).For context, PRoMPT BOLUS (9,041 children, 47 departments, five countries) found no difference in major adverse kidney events between balanced fluid and 0.9% saline (3.4% vs 3.0%), with less hyperchloraemia in the balanced-fluid group.For practice, the converging message is that the fluid you choose matters less than hoped, while the volume you give may matter more than thought. This supports the titrated, reassess-after-each-bolus approach that NICE and APLS already ask for, rather than a fixed escalator.Important caveat: the bolus–mortality association is unadjusted and observational, and the sickest children in refractory shock receive the most bolus fluid, so this does not show that boluses cause harm and is not a reason to withhold fluid from a shocked child.Reference: Long E, Selman C, Borland ML, et al. Archives of Disease in Childhood. Published May 2026. DOI: https://doi.org/10.1136/archdischild-2025-330189━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━MAIN STORY 2: How risky is the febrile two-month-old? ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━The sixty-to-ninety-day-old is the febrile infant our guidelines treat least consistently — some pathways stop at sixty days, others lump the whole under-ninety group together. This meta-analysis supplies the missing denominator for that group, completing a run that has moved from risk stratification, through practice variation, to underlying prevalence.Key findings:59 studies, 20 distinct datasets, just under 34,835 well-appearing, previously healthy febrile infants aged 60–90 days.Pooled prevalence of invasive bacterial infection was 1.11% (95% CI 0.84–1.47), roughly 1 in 90.Almost all of that was bacteraemia at 1.01%; bacterial meningitis was rare at 0.11%, roughly 1 in 900.Estimates held across every sensitivity analysis, including removal of the single largest study.The clinical bottom line is a number to carry into both your own reasoning and the conversation with parents: in the well infant in this band, meningitis risk of around one in nine hundred is a reasonable thing to weigh when deciding whether this particular baby needs a lumbar puncture or a more measured pathway with good safety-netting.These are international data, so map the figures onto your local febrile infant pathway and the NICE traffic-light thresholds rather than applying them in isolation.Reference: Dionisopoulos Z, Sabhaney V, D'Arienzo D, et al. JAMA Pediatrics. Published May 2026. DOI: https://doi.org/10.1001/jamapediatrics.2026.1815━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━.WHAT'S CAUGHT MY EYE ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━1. TWIST and ultrasound for the acute scrotumA retrospective study of just...
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    16 分
  • Episode 84: The Febrile Infant Lottery

    Episode 84: The Febrile Infant Lottery
    2026/05/24
    2 PAEDS IN A POD Episode 84 | The Febrile Infant Lottery Released: 24/5/2026 | Runtime: ~20 minutes━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ EPISODE SUMMARY ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━This episode opens with a large London study showing that the care a febrile young infant receives depends heavily on which hospital they attend, with full adherence to national guidance achieved in only one in five presentations and over-investigation almost as common as under-investigation. The second main story examines a French randomised controlled trial of automated closed-loop oxygen titration in bronchiolitis — negative on its primary endpoint of length of stay, but with coherent secondary signals on saturation targeting and oxygen flow that make it a useful lesson in reading past the abstract. What's Caught My Eye covers a systematic review of electronic sepsis alerts in children, a multicentre cohort of in-hospital neonatal head injury on the postnatal ward, and a study asking whether comprehensive respiratory virus panels change outcomes in discharged children.━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━MAIN STORY 1: How much does the febrile infant's hospital matter? ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━The febrile infant under ninety days is one of the highest-stakes presentations in paediatric emergency and acute care. National guidance exists precisely to compress that diagnostic uncertainty into something consistent. This retrospective study across twenty-one London hospitals, run through the London REACH network, tested whether care actually looks the same once that guidance is applied — and the answer is that it does not.Key findings:2,008 presentations of infants aged 90 days or younger; 41.1% were febrile at the point of assessmentBlood tests performed in 73.7% overall, but ranging from 55.4% to 96.7% across sites; lumbar puncture 40.8% overall, range 17.1% to 70.7%; urinalysis 63.4% overall, range 43.4% to 85.4%Antibiotics started in 57.7% overall (site range 35.4% to 90.2%); admission in 63.5% overall (site range 46.7% to 99.2%)Full adherence to national clinical practice guidelines in only 21.9% of presentations; partial adherence 24.4%; non-adherence 31.2%; over-adherence 23.5%Adherence was higher in infants under 28 days and in those febrile during assessmentThe clinical message is that variation runs hard in both directions. We tend to fear under-investigation and the missed serious bacterial infection, but over-investigation — unnecessary lumbar puncture, septic screen, intravenous antibiotics and admission in a well baby — was almost as common, and it is not a neutral act. The practical focus for departments is the infant who is afebrile by the time they are assessed, where the guidance gives least direction and the variation is widest.This is London-specific, retrospective, and the study period overlaps the later pandemic, so the absolute numbers will not transfer directly to a district general setting.Habermann S, Hartzenberg R, Loucaides EM, et al. (London REACH Network). Variation in management of febrile infants younger than 90 days across London: a retrospective cohort study. European Journal of Pediatrics. 2026;185(6). https://doi.org/10.1007/s00431-026-06938-y━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━MAIN STORY 2: Automated oxygen titration in bronchiolitis ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━Oxygen titration in bronchiolitis is a constant low-level drain on nursing time across the winter. This trial tested whether handing the titration to a closed-loop device improves the outcome that matters to families and to flow — length of hospital stay.Key findings:Multicentre randomised controlled trial, ten paediatric departments in France, 2018 to 2023; 103 infants aged 1 to 12 months with acute bronchiolitis requiring oxygen, severe bronchiolitis excludedPrimary endpoint negative: median stay 71.0 hours with the FreeO2 device versus 69.6 hours with manual titration (p=0.39)Time within the target oxygen saturation zone 89.4% with automation versus 74.9% with manual titration (p<0.05)Median oxygen flow 0.1 L/min with automation versus 0.3 L/min manual (p<0.05); no significant difference in re-hospitalisation at 7 or 30 days or in non-invasive ventilation useThe bottom line is that automated titration does not shorten length of stay, so it should not be argued for on that basis, but the secondary signals are coherent — better time in target range at lower oxygen flows. The wider teaching point is that a negative primary endpoint in an underpowered trial is ...
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    18 分
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