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Two Paeds In A Pod

Two Paeds In A Pod

By: Dr Ian Lewins
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About this listen

 2 Paeds in a Pod is a clinical paediatrics podcast exploring the decisions, dilemmas, and systems that shape everyday practice. While rooted in paediatric emergency medicine, the conversations range across the breadth of paediatrics — from acute presentations and diagnostic uncertainty to wider service design, professional development, and the evolving evidence base. Each episode brings structured discussion to real-world clinical questions. Alongside practical case-based reflection, we highlight research that has caught our eye and consider how emerging evidence should — or should not — influence frontline care. This podcast is for paediatric consultants, trainees, advanced practitioners, and clinicians who want thoughtful, evidence-aware conversation grounded in the realities of modern practice. This podcast is for medical education purposes only and should not replace advice you have received from a medical practitioner.All rights reserved Hygiene & Healthy Living Physical Illness & Disease Science
Episodes
  • IV Aminophylline in Acute Severe Asthma: Does It Still Have a Role in Paediatric Emergency Care?

    IV Aminophylline in Acute Severe Asthma: Does It Still Have a Role in Paediatric Emergency Care?
    Oct 25 2025

    Clinical Question

    In children presenting with acute severe asthma, does intravenous aminophylline improve meaningful clinical outcomes compared to standard therapy?


    ⸻


    Background


    IV aminophylline has historically been used as a second-line infusion in severe paediatric asthma. However, contemporary escalation strategies increasingly prioritise:

    • Oxygen

    • High-dose nebulised salbutamol

    • Systemic corticosteroids

    • IV magnesium sulphate


    This raises the question: does aminophylline still offer incremental benefit?


    ⸻


    The Evidence Reviewed


    A systematic review published in Archives of Disease in Childhood analysed:

    • 9 randomised controlled trials

    • 466 children

    • Standard therapy ± IV aminophylline


    Outcomes assessed:

    • Asthma severity scores

    • Length of stay

    • Admission rates

    • PICU admission

    • Intubation rates

    • Adverse effects


    ⸻


    Key Findings


    No significant benefit in:

    • Speed of clinical improvement

    • Admission rates

    • PICU transfer

    • Intubation rates

    • Length of hospital stay


    Significant increase in adverse effects:

    • Nausea and vomiting (3–5x higher)

    • Headache

    • Tremor

    • Irritability

    • Arrhythmias


    Overall: No improvement in meaningful outcomes, with increased morbidity.


    ⸻


    Important Caveat


    A 1998 study (Young & South) suggested possible benefit in the most critically unwell, treatment-refractory children, including:

    • Reduced duration of intubation

    • Potential improvement in lung function


    This suggests a potential narrow rescue-therapy window.


    ⸻


    Implications for Paediatric Emergency Practice (2025)


    Current best evidence supports:

    1. Oxygen

    2. Nebulised salbutamol

    3. Systemic corticosteroids

    4. IV magnesium

    5. Structured escalation planning


    IV aminophylline should be considered:

    • A rescue therapy of last resort

    • Not routine second-line treatment


    ⸻


    Take-Home Message


    IV aminophylline has historical presence but limited modern evidence of benefit. For most children with acute severe asthma, it increases adverse effects without improving outcomes.


    Its role in 2025: rare, selective, and critically contextual.
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    3 mins
  • Episode 82: The FIDO study

    Episode 82: The FIDO study
    Dec 21 2024

    In this episode we talk to Dr Etimbuk Umana, the lead author of the FIDO study looking at the management of febrile infants in the Emergency Department. FIDO is a PERUKI sponsored study and was recently published in The Lancet: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00540-6/fulltext
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    31 mins
  • Episode 81: Priority Setting in PEM research with PERUKI

    Episode 81: Priority Setting in PEM research with PERUKI
    May 12 2024
    2 Paeds returns with a fresh new look, new in association with team at PERUKI. In our first collaboration we talk to Dr Charlotte Sloane about the current major PERUKI project - establishing the current research priorities for the next 5 years in paediatric emergency medicine. If you want to get involved go to www.peruki.org.uk or email Charlotte at csloane04@qub.ac.uk You can also watch us on YouTube
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    26 mins
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