Therapeutic hypothermia and outcome in hyponatraemic encephalopathy secondary to maternal water intoxication.

Misguided encouragement to consume large volumes of water during labour for pain relief results in dilutional hyponatraemia in mothers and their babies presenting with neurological dysfunction. We report three babies who were encephalopathic with seizures in the background of hyponatraemia secondary to maternal ingestion of large volumes of water and mild perinatal asphyxia. All babies underwent therapeutic hypothermia in addition to sodium supplementation with fluid restriction. Their neurodevelopment was appropriate for age. This case series highlights the dilemma that could arise with hyponatraemic encephalopathy and mild perinatal asphyxia in the first 6 hours of life, which is the window of opportunity for therapeutic hypothermia for hypoxic-ischaemic encephalopathy. It is important to educate pregnant mothers in labour on the adverse effects of excessive fluid ingestion.

Do oral steroids aid recovery in children with Bell's palsy?

There is growing evidence that steroids are not beneficial for treatment of paediatric patients with Bell's palsy. To investigate, we conducted a retrospective longitudinal study examining notes of 100 children, over 12 years coded for facial nerve palsy. Of the 79 diagnosed with Bell's palsy, all recovered, and for 46 patients we had data on interval from onset of symptoms to resolution (median duration in treated group = 5 weeks, range = 39; median duration in untreated group = 6 weeks, range = 11; P = .86). From our results, we conclude that all children with Bell's palsy recovered, with or without steroid treatment, with no statistically significant difference in symptoms duration. Complications of unresolved Bell's palsy can have important long-term functional and psychosocial consequences. Therefore, we need further research on use of steroids in children with complete/severe cases; it would be a shame to omit treatment due to "absence of evidence" rather than "evidence of absence."

Strangulated diaphragmatic hernia presenting at 7 weeks of life as intractable shock.

A 7-week-old infant presented to hospital pale and floppy, with 5 s capillary refill time. Blood gas showed severe acidosis (pH 6.86, partial pressure of carbondioxide 10.55 kPa, base excess 21.1). Hypotension persisted despite several fluid boluses so she was intubated and started on inotropic support. A chest X-ray revealed a congenital diaphragmatic hernia (CDH). Despite steroids and blood transfusions she remained unstable, and could not be resuscitated following cardiac arrest. Postmortem revealed 39 cm of herniated, necrotic colon. 5-25% of CDH presents after the neonatal period, and while not associated with pulmonary hypoplasia is primarily still a diaphragmatic defect. In late presenting cases, herniation occurs shortly prior to developing symptoms; therefore, an antenatal ultrasound (US) cannot pick it up. If we could diagnose the isolated diaphragmatic defect antenatally, this would allow elective postnatal surgical closure. This is not feasible currently; however, with the advent of antenatal three-dimensional US scans it may be possible in the future.