Highlights from this issue
Unpredictability ‘The world is so unpredictable. Things happen suddenly, unexpectedly... We want to feel we are in control of our own existence. In some ways we are, in some ways we’re not. We are ruled by the forces of chance and coincidence’. The words of the American author, Paul Auster and particularly relevant during a week in which the rate of new (Covid-19) coronavirus infections, literally weeks after first detection in December 2019, has accelerated to pandemic levels. Though, through different lenses, each of this month’s papers looks at (un)predictability Self-harm in primary care Self-harm strongly predicts later suicide, up to 80% of those committing suicide having had a primary or secondary care mental health contact in the year before death. Self-harm data is therefore crucial to suicide prevention efforts. Approximately twice as many people who self-harm seek help in primary care than access secondary care....
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The genetic crystal ball: new answers and new questions for infants with neuromuscular disorders and respiratory failure
A male infant is born at term in unexpectedly poor condition. He needs immediate resuscitation including respiratory support and is admitted to the neonatal intensive care unit. The infant is treated initially for suspected hypoxic-ischaemic encephalopathy, but he remains ventilator dependent. Over the coming weeks, it becomes apparent that he may have an underlying neuromuscular disorder. The medical team orders various investigations, including genetic testing. Subsequently, the results indicate that he has X linked myotubular myopathy (XLMTM), a rare, severe, life-limiting congenital myopathy. In the ensuing weeks, the infant’s parents have long discussions with the clinical team caring for him. What does the future hold for him? For how long might he live? Will he be able to breathe without respiratory support? Would it be in his best interests to have a tracheostomy and continued mechanical ventilation? Or would it be best to withdraw his current respiratory support and...
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Child death review statutory and operational guidance: maximising learning from child deaths
Introduction A total of 4015 deaths of children aged between 0 and 18 years were registered in England and Wales in 2017.1 Every one of these deaths was a devastating loss that profoundly affected parents as well as siblings, grandparents, extended family and friends. Each death also affected the professionals involved in caring for the child during or at the end of their life. If child mortality rates are regarded as a ‘yardstick’ of a country’s ability to care for the most vulnerable in society, then the UK has fallen far behind its European neighbours.2 3 While the reasons for this are complex, we are not performing well as a nation in addressing known modifiable factors that impact on children’s deaths. This paper summarises the background to child death review in England, the evolving regulatory and legislative landscape and highlights the essential...
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Large simple pneumothorax? Consider conservative treatment
When faced with a spontaneous simple pneumothorax, in a previously well child the Archivist would probably leave the smallest of air leaks alone (in a child with no symptoms) and follow-up conservatively. Some sort of intervention is usually advised for the bigger pneumothoraces and written guidelines, often extrapolated from adult evidence, recommend drainage. A large Australian paediatric case series by Robinson et al (http://dx.doi.org/10.1136/archdischild-2014-306696) showed most children had an intervention. Can the adult literature help us? Brown SGA et al(N Engl J Med 2020; 382:405–415 DOI: 10.1056/NEJMoa191077) have published, also from Australia, the results of a randomised controlled study of conservative treatment versus intervention in larger pneumothoraces (primary spontaneous pneumothorax of 32% or more on chest radiography according to the Collins method (sum of interpleural distances, >6 cm)). It is an adult study but included a study cohort aged 14 and above. I think it is worthwhile examining....
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