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Background and Aims: Urinary Tract Infection (UTI) is one of the most common infections in paediatric population. The choice of first line antibiotic for empirical treatment must follow the trend of causative organisms and its sensitivity pattern. Based on previous analysis and low resistance rate, we use Cephalexin as the first line antibiotic for uncomplicated lower UTIs. A retrospective analysis of urine samples was carried out to evaluate the causative organisms and antibiotic resistance in a district general hospital setting.

Methods: This was a retrospective study analysing urine microscopy and culture reports of all infants and children visiting the paediatric department between 2016 and 2019. 307 sample reports were analysed using Microsoft Excel.

Results: Of the 307 samples tested, 29 were from male patients with male to female ratio of 1:10. 261 (85%) samples grew coliform species whereas 46 (15%) grew other organisms. Coliform was most resistant to amoxicillin (50%) and Trimethoprim (42%). Compared to previous years data, resistance to cephalexin has increased from < 10% to 22% whereas it remains low to Nitrofurantoin (6%).

Conclusions: Coliform species remain the most common uropathogen in the paediatric population. Resistance pattern to Amoxicillin and Trimethoprim remains high in our catchment population. Worryingly, resistance to Cephalexin is on the rise. Caution should be exercised in blindly using Cephalexin as first line antibiotic for treating all UTIs in children. We recommend using appropriate antibiotic based on sensitivity report if urine culture is available prior to commencing the treatment.

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Objective: Renal dysfunction is commonly associated with Neonatal Encephalopathy and long-term neurological sequelae. We assessed renal dysfunction and measured more sensitive urinary biomarkers in children who had Neonatal Encephalopathy (NE) compared with age-matched controls to evaluate resolution of neonatal renal dysfunction.

Method: Infants with NE were followed up at school age and renal function was measured and compared with age matched controls (n=60). Urinary biomarkers including albumin, beta-2 microglobulin, cystatin-C, epidermal growth factor, neutrophil gelatinase-associated lipocalin, osteopontin and uromodulin were analysed in children with NE and controls using ELISA. We also retrospectively assessed the neonatal data and compared the results at infancy and childhood.

Results: Serum creatinine and urea levels were significantly elevated in school age children with NE (n=55) compared to controls (n=60). A significant rise in urinary biomarkers NGAL and Cystatin C was seen in children with moderate to severe NE (NE grade II/III) compared to children with mild NE (NE 0/I) and controls. Similar results were noted in the neonatal period in the infants with NE.

Interpretation: School-age children post-NE had significantly altered renal function. Therefore, long term renal follow up as well as multiorgan assessment is indicated in children with neonatal AKI.

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Objective: To evaluate early and long-term complications, aesthetic result, costs, procedure time, and quality of life (QoL) for tissue adhesive versus suture to repair facial lacerations in children.

Design: Prospective, controlled, single-blind study
Setting: Emergency Department of the University Children’s Hospital Zurich
Participants: Children with facial lacerations presenting between 07/2017 and 08/2018

Methods: Outcome was assessed by 5 independent, blinded plastic surgeons by means of photographs at 6-12 months using the modified Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). Additionally, POSAS was performed at day 5-10 (early follow-up) and month 6-12 (late follow-up) by the patients and the physician. Complications and QoL were assessed by standardized measures.

Results: 96 wounds were closed using tissue adhesives (group 1); 134 were sutured (group 2). Mean POSAS score was 2.1 ± 0.7 in group 1 and 2.5 ± 0.7 in group 2 (p< 0.001), mean VSS score was 1.2 ± 0.9 in group 1 and 1.6 ± 0.9 in group 2, (p< 0.001). At early follow-up, dehiscence rate was 12.5% in group 1 and 3.7% in group 2 (p< 0.001). At late follow-up, 1 dehiscence remained per group. No QoL impairment was found at long-term follow-up. Mean procedure time was significantly shorter in group 1 (6.3 ± 4.0 min vs. 11.6 ± 7.2 min; p< 0.001). Treatment costs were 33.5% lower in group 1.

Conclusion: Tissue adhesive and suture yield favorable aesthetic results and lead to low complication rates. The use of adhesives is less expensive and faster, offering therefore considerable advantages when used appropriately.