1The Rotunda Hospital, Dublin, Ireland Introduction:
The humerus is second only to the clavicle as the most commonly fractured bone associated with birth trauma. Neonatal humeral fractures result from rotation or hyperextension of the upper extremity during delivery. A complete transverse midshaft fracture at the medial third of the humerus is the typical fracture site and type. Supracondylar fractures which are very common in paediatrics are rare in neonates and carry significant potential for neurovascular compromise.
Aim:
To highlight a case of a misdiagnosed fracture in a neonate as a result of artefact.
Method:
A case report of a male infant was born at 26+6 weeks gestation at our hospital by emergency section for maternal pre-eclampsia. He was ventilated in theatre for respiratory distress and his x-ray on arrival to the NICU to check his ET tube position revealed a suspected fully displaced right supracondylar fracture.
Results:
The paediatric orthopaedic team in a tertiary paediatric hospital was contacted as immediate
consultation is advised in the case of a displaced supracondylar fracture. We decided to x-ray the right arm. This suprisingly revealed no fracture. The appearance of a fracture on the initial x-ray was as a result of artefact from the tubing of the blood pressure cuff.
Conclusion:
This case highlights the importance of not diagnosing a fracture on an x-ray taken for another purpose.
The humerus is not optimally seen on a chest radiograph and therefore views of the humerus should be taken before diagnosing a fracture.
SEPSIS IN PRETERM INFANTS DELIVERED BY ELECTIVE LSCS C Gormley1, E Houlihan1, C Gaffney2, N McCallion1,2
1Neonatology, RCSI, Dublin, Ireland
2Paediatrics, ROtunda Hospital, Dublin, Ireland Background:
Preterm infants are at an increased risk of developing early-onset sepsis, and preterm labour is a risk factor for developing sepsis. Most preterm infants are given intravenous antibiotics following delivery.
Elective or semi-elective delivery of preterm infants by caesarian section (LSCS) is not necessarily a risk factor for sepsis where there are no other septic concerns. Nonetheless, many infants are routinely treated with intravenous antibiotics.
Aim:
Review the incidence of early onset sepsis or suspected early onset sepsis in infants delivered prematurely by LCSC for a non-spetic indication (maternal PET).
Methods:
Retrospective chart review of all VLBW infants under 34 weeks gestation who were admitted to the NICU in the Rotunda Hospital between the 2008-2011 inclusive who were delivered by LSCS for maternal PET. Infant demographic data were recorded. All blood cultures, CRP and full blood counts from the first week of life were obtained and the results analyzed.
Results: 79 infants of <34 weeks gestation and <1500g were identified who had been delivered by LSCS for maternal PET. All had septic work ups on admission to the NICU and were treated with minimum 48 hours of antibiotics. The septic screens included FBC, CRP and blood culture results at both 48 hour and 5 days. On review of all 79 septic screens, none of the infants had positive blood cultures at either 48 hours or 5 days. Similarly, none of the infants displayed any signs indicative of early-onset sepsis on full blood count or CRP level. Mild deviations were observed in some of the haematological results, but these can explained by the effects of PET on the infant.
Conclusion:
None of the infants studied had any evidence of sepsis on septic screen but all were treated with IV antibiotics because of prematurity due to LSCS for maternal PET.
REVIEW OF OSTEOSARCOMA AND EWING’S SARCOMA IN CHILDREN <16 TREATED IN THE ROYAL BELFAST HOSPITAL FOR SICK CHILDREN SINCE 2000.
E McGovern1, A McCarthy2
1Various Departments, Royal Group Of Hospitals, Belfast, N.Ireland
2Paediatric Oncology, Royal Belfast Hospital for Sick Children, Belfast, N.Ireland Aim
The aim of this audit is to gain information on the incidence, age at diagnosis, gender ratio, tumour location, presentation, treatment and outcome of patients under the age of 16 who were diagnosed with and treated for a malignant bony tumour in Royal Belfast Hospital for Sick Children (RBHSC) since 2000.
Methods
Patient lists were formed by searching the hospital’s oncology databases and records held by the haematology/oncology research nurse.
Results
In total there were 28 patients.
13 (46.4%) were Ewing’s sarcoma and 15 (53.6%) were osteosarcomas.
50% were male.
The age ranged from 5-15.
The femur was the most common primary site (36%).
Surgical techniques included total or partial limb amputation and limb sparing resection.
All patients with Ewing’s sarcoma were enrolled in the EURO-EWING’s 99 trial. Osteosarcoma patients were not formally enrolled in a trial, but 13/15 patients had their treatment based on the EURAMOS trial and 2/15 patients on the EORTC 80931 trial.
28.6% are still receiving treatment for their primary malignancy. 32% have completed all treatment and have not suffered a recurrence. 28.6% have passed away. 11% (3 patients) are currently receiving treatment for a relapse, 2 of whom are receiving palliative care.
Outcome has been compared to histological response to pre-operative chemotherapy.
Conclusion
This a regional audit from the single centre in Northern Ireland. The review spans over only 11 years.
Many of the typical features of osteosarcoma and Ewing’s sarcoma as described in the literature were observed in this review. Patients with poor response to initial chemotherapy, metastatic disease at diagnosis or disease recurrence continue to fare badly. Clinical trials testing new chemotherapeutic agents and novel targeted therapies are constantly on-going.