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ObjectivesIn 2008, new statutory national procedures for responding to unexpected child deaths were introduced throughout England. There has, to date, been no national audit of these procedures.Study designFamilies bereaved by the unexpected death of a child under 4 years of age since 2008 were invited to participate. Factors contributing to the death and investigations after the death were explored. Telephone interviews were conducted, and coroners’ documents were obtained. The nature and quality of investigations was compared with the required procedures; information on each case was reviewed by a multiagency panel; and the death was categorised using the Avon clinicopathological classification.ResultsData were obtained from 91 bereaved families (64 infant deaths and 27 children aged 1–3 years); 85 remained unexplained after postmortem examination. Documentation of multiagency assessments was poorly recorded. Most (88%) families received a home visit from the police, but few (37%) received joint visits by police and healthcare professionals. Postmortem examinations closely followed national guidance; 94% involved paediatric pathologists; 61% of families had a final meeting with a paediatrician to explain the investigation outcome. There was no improvement in frequency of home visits by health professionals or final meetings with paediatricians between 2008–2013 and 2014–2017 and no improvement in parental satisfaction with the process.ConclusionsStatutory procedures need to be followed more closely. The implementation of a national child mortality database from 2019 will allow continuing audit of the quality of investigations after unexpected child deaths. An important area amenable to improvement is increased involvement by paediatricians.

Being involved in a complaint or serious incident can be a huge stress for a doctor, whether a trainee or consultant. When affected, it is important to be able to look for the support of a colleague or a more senior person, and just as importantly, those not directly involved need to know what to do to provide support. In this piece I consider what ‘support’ really means, I provide some tips on what to do and what not to do, and I consider how incidents and complaints can need different approaches.

In the past century, child mortality has fallen to very low rates in all developed countries. However, rates between and within countries vary widely, and factors can be identified that could be modified to reduce the risk of future deaths. An understanding of the nature and patterns of child death and of the factors contributing to child deaths is essential to drive preventive initiatives. We discuss the epidemiology of child deaths in England and Wales. We use available data, particularly that of death registration and other available datasets, and published literature to emphasise issues relevant to reduction of child deaths in developed countries. We examine the different patterns of mortality at different ages in five broad categories of death: perinatal causes, congenital abnormalities, acquired natural causes, external causes, and unexplained deaths. For each category, we explore what is known about the main causes of death and some of the contributory factors. We then explain how this knowledge might be used to help to drive prevention initiatives.

Focuses on the commitment of hospitals to bedsharing between mothers and infants in Great Britain. Encouragement for the early establishment and continued promotion of breastfeeding; Implications of skin-to-skin contact guidelines between the mother and child; Information on the development of bedding-in policies among hospitals.

People are full of useful advice, especially when you make the transition to the senior doctor grade. We present a very helpful model we have used over some time to aid us when we have issues.

There are few data which indicate benefit from the use of opiates during mechanical ventilation in preterm babies. We have investigated the effect of sedative doses of alfentanil on intermediary metabolism.Ventilated preterm babies were randomised to receive alfentanil (20 ug/kg bolus & 5 ug/kg/hr) or placebo as a pilot study. Samples were taken pre-dose, 1 hour post-dose and twice daily during infusion. No other change in routine management occurred during the trial. Median birthweight of the study group was 1300g (r:726-2352g), gestation: 29 weeks (26-36 weeks).Twelve babies received alfentanil from a median age of 16 hours (r: 12-36) after birth and 12 babies a placebo infusion from 24 hours (r:10-32). No differences in heart rate, blood pressure or pH were seen between the study groups and similar rates of perinatal complications were seen in each group.During the administration of alfentanil, glucose rose by 2.02 mmol/l (sem: 1.67) compared to a fall of 0.87 mmol/l (2.94) in the placebo group 1 hour post-dose, and remained on average 1.27 (1.71) mmol/l higher than baseline over the next 24 hours, compared to 2.64 (1.78) mmol/l less among controls. Similar rises in lactate, pyruvate, glycerol were observed in the alfentanil group which persisted over the next 24 hours, in contrast to the anticipated falt. There were no differences in urinary catecholamine excretion.These data suggest that sedative doses of alfentanil may have no immediate metabolic benefit.