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Publication Quantitative assessment of multiorgan sequestration of parasites in fatal pediatric cerebral malaria(Oxford University Press, 2015-04-07) Milner, Danny A. Jr; Lee, Jonathan J.; Frantzreb, Charles; Whitten, Richard O.; Kamiza, Steve; Carr, Richard; Pradham, Alana; Factor, Rachel E.; Playforth, Krupa; Liomba, George; Dzamalala, Charles; Seydel, Karl B.; Molyneux, Malcolm E.; Taylor, Terrie E.; Brigham and Women's Hospital, Boston, USA; Harvard University, Boston, USA; University of Malawi College of Medicine, Blantyre, Malawi; CellNetix, Olympia, USA; South Warwickshire University NHS Foundation Trust; Michigan State University, East Lansing, USA; Liverpool School of Tropical Medicine; University of Liverpool; Histopathology; Medical and Dental; Carr, Richard A.Children in sub-Saharan Africa continue to acquire and die from cerebral malaria, despite efforts to control or eliminate the causative agent, Plasmodium falciparum. We present a quantitative histopathological assessment of the sequestration of parasitized erythrocytes in multiple organs obtained during a prospective series of 103 autopsies performed between 1996 and 2010 in Blantyre, Malawi, on pediatric patients who died from cerebral malaria and controls. After the brain, sequestration of parasites was most intense in the gastrointestinal tract, both in patients with cerebral malaria and those with parasitemia in other organs. Within cases of histologically defined cerebral malaria, which includes phenotypes termed "sequestration only" (CM1) and "sequestration with extravascular pathology" (CM2), CM1 was associated with large parasite numbers in the spleen and CM2 with intense parasite sequestration in the skin. A striking histological finding overall was the marked sequestration of parasitized erythrocytes across most organs in patients with fatal cerebral malaria, supporting the hypothesis that the disease is, in part, a result of a high level of total-body parasite sequestration. Keywords: Africa; Malawi; autopsy; cerebral malaria; pathology; pediatricsPublication Paediatric palliative care(Elsevier, 2015-06-06) Thompson, Angela; South Warwickshire University NHS Foundation Trust; Zoe's Place Baby Hospice, Coventry; Paediatrics; Medical and Dental; Thompson, AngelaChildren with palliative care needs are increasing in prevalence and complexity of need. 49,000 children (under 19 years) were estimated to be living in the UK in 2012 with a life limiting/life threatening condition that might require palliative care. Palliative care requires a total and active approach, with transparent, communicated, agreed provision of appropriate and proportionate care. Planning improves care, supported by documentation of plans. Advance planning enables management of both reversible and chronic aspects of the condition, as well as utilising parallel planning when end of life approaches. Challenges in palliative care include the commissioning of sustainable services across organisations to deliver, often over years, but sometimes briefly and rapidly, 24/7 access to skilled palliative care, including hands on care at the end of life. Care is integrally intertwined with other clinical, social, education and voluntary services to ensure that families receive the spectrum of care required throughout their journey. Keywords advance care; best interest; end of life; life limiting; palliative; parallel planning; planning; sustainablePublication Blended foods for tube-fed children : a safe and realistic option? A rapid review of the evidence(BMJ Publishing Group, 2016-10-18) Coad, Jane; Toft, Alex; Lapwood, Susie; Manning, Joseph; Hunter, Mark; Jenkins, Huw; Sadlier, Clare; Hammonds, Julie; Kennedy, Ailsa; Murch, Simon; Widdas, David; Coventry University; Helen and Douglas House, Oxford; University of Nottingham; Nottingham Children's Hospital; Acorns Children's Hospices, Birmingham; University Hospital of Wales, Cardiff; Hope House Children's Hospices, Morda; Liverpool Community Health; University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; Community and Children's Services; Nursing and Midwifery Registered; Widdas, DavidWith the growing number of children and young people with complex care needs or life-limiting conditions, alternative routes for nutrition have been established (such as gastrostomy feeding). The conditions of children and young people who require such feeding are diverse but could relate to problems with swallowing (dysphagia), digestive disorders or neurological/muscular disorders. However, the use of a blended diet as an alternative to prescribed formula feeds for children fed via a gastrostomy is a contentious issue for clinicians and researchers. From a rapid review of the literature, we identify that current evidence falls into three categories: (1) those who feel that the use of a blended diet is unsafe and substandard; (2) those who see benefits of such a diet as an alternative in particular circumstances (eg, to reduce constipation) and (3) those who see merit in the blended diet but are cautious to proclaim potential benefits due to the lack of clinical research. There may be some benefits to using blended diets, although concerns around safety, nutrition and practical issues remain. Keywords: blended diet; children; enteral; gastrostomy; young people.Publication Cystic fibrosis, lockdown and CFTR modulators - a perfect storm(Elsevier, 2022-06) Hufton, M.; Hussaini, Y.; Desai, M.; Saleem, N.; Srikantaiah, R.; Fairbank, J.; Cooper, S.; Paskin, L.; University Hospitals Coventry and Warwickshire NHS Trust; South Warwickshire University NHS Foundation Trust; Birmingham Childrens Hospital; Coventry and Warwickshire Partnership Trust; Community Children's Nursing; Nursing and Midwifery Registered; Hussaini, Y.Conference abstract WS20.05 in the section 'Complex psychosocial/nursing case studies' of the oral sessions of the 45th European Cystic Fibrosis Conference, 8-11 June 2022, Rotterdam, The Netherlands.Publication Effects of maternal caffeine consumption on the breastfed child: a systematic review(SMW supporting association, 2018-09-28) McCreedy, Aimee; Bird, Sumedha; Brown, Lucy J; Shaw-Stewart, James; Yen-Fu, Chen; University of Warwick; South Warwickshire University NHS Foundation Trust; Paediatrics; Medical and Dental; Bird, SumedhaBackground: Nutrition in the first 1000 days between pregnancy and 24 months of life is critical for child health, and exclusive breastfeeding is promoted as the infant's best source of nutrition in the first 6 months. Caffeine is a central nervous system stimulant occurring naturally in some foods and used to treat primary apnoea in premature babies. However high caffeine intake can be harmful, and caffeine is transmitted into breastmilk. Aim: To systematically review the evidence on the effects of maternal caffeine consumption during breastfeeding on the breastfed child. Method: A systematic search was conducted to October 2017 in MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library. The British Library catalogue, which covers doctoral theses, was searched and PRISMA guidelines followed. Two reviewers screened for experimental, cohort, or case-control studies and performed independent quality assessment using the Newcastle-Ottawa scale. The main reviewer performed data extraction, checked by the second reviewer. Results: Two cohort, two crossover studies, and one N-of-1 trial were included for narrative synthesis. One crossover and two cohort studies of small sample sizes directly investigated maternal caffeine consumption. No significant effects on 24-hour heart rate, 24-hour sleep time, or frequent night waking of the breastfed child were found. One study found a decreased rate of full breastfeeding at 6 months postpartum. Two studies indirectly investigated caffeine exposure. Maternal chocolate and coffee consumption was associated with increased infant colic, and severe to moderate exacerbation of infant atopic dermatitis. However, whether caffeine was the causal ingredient is questionable. The insufficient and inconsistent evidence available had quality issues impeding conclusions on the effects of maternal caffeine consumption on the breastfed child. Conclusion: Evidence for recommendations on caffeine intake for breastfeeding women is scant, of limited quality and inconclusive. Birth cohort studies investigating the potential positive and negative effects of various levels of maternal caffeine consumption on the breastfed child and breastfeeding mother could improve the knowledge base and allow evidence-based advice for breastfeeding mothers. Systematic review registration number: CRD42017078790.Publication Haemophagocytic lymphohystiocytosis (hlh) should be considered early in the work up of prolonged fever -experience from a secondary level paediatric unit in england(BMJ Publishing Group, 2019-05) Chacko, Aju; South Warwickshire University NHS Foundation Trust; Paediatrics; Medical and Dental; Chacko, A. P.This British Society of Haematology and UK Children’s Cancer and Leukaemia Care abstract from the Royal College of Paediatrics and Child Health Conference and exhibition 2019 argues that haemophagocytic lymphohystiocytosis (HLH) should be considered early in the work up of prolonged fever, based on experience from a secondary level paediatric unit in England.Publication 'Our relationship is different': exploring mothers' early experiences of bonding to their twins(Taylor and Francis Group, 2020-02-10) Gowling, Sarah A; McKenzie-McHarg, Kirstie; Harrison, Lesley; Gordon, Carolyn; University of Coventry; Department of Clinical Health Psychology, Warwick Hospital, Warwick, UK; Department of Clinical Health Psychology; Additional Professional Scientific and Technical Field; McKenzie-McHarg, KirstieObjective: The aim of this research was to explore mothers' lived experience of early bonding with their twins.Background: Research has suggested that the process of bonding with twins may differ from that of bonding with singletons. However, there is limited research exploring this experience from the mother's perspective.Method: An IPA study involved six participants in semi-structured interviews.Results: Two superordinate themes emerged; 'Twin guilt and shame' and 'I missed out … they miss out'. Results suggested the experience of bonding with two infants simultaneously generated guilt for the mothers, who at points felt that they and their infants had missed out and had had to adapt.Conclusion: The experience of bonding with twins can be complex and take longer than anticipated, with mothers reporting the experience as being different from their expectations. Having a greater understanding and information about the complexities of bonding with twins would be beneficial for both mothers and professionals working with them.Publication The nutritional needs of moderate-late preterm infants(MA Healthcare, 2022-04) Johnson, Mark J.; King, Caroline; Boddy, Bethany; Craig, Stan; Males, Joanna; McEwan, Tom; Tagani, Stephanie; University Hospital Southampton; University of Southampton; South Warwickshire University NHS Foundation Trust; Belfast Health and Social Care Trust; Dorset County Hospital; NHS Education for Scotland; Imperial College Healthcare NHS Trust; Paediatrics; Nursing and Midwifery Registered; Boddy, BethanyThis article discusses the nutritional needs of moderate and late preterm infants (born between 32+0weeks and 36+6weeks' gestation) and makes recommendations for best practice both while these infants are in hospital and when they are discharged into the community. These recommendations were derived following a roundtable meeting of a group comprising two neonatologists, three paediatric dietitians, a health visitor/paediatric nurse and a midwife practitioner. The meeting and medical writing assistance was sponsored by Nutricia. None of the participants accepted honoraria for their contributions to the discussion.