Neonatal mastitis and abscess are rare and most often unilateral. Neonatal breast massage for physiological breast hypertrophy is suspected to be a predisposing factor in the case reported here: a 14-day-old neonate with bilateral neonatal breast abscess, treated effectively with intravenous cloxacillin and surgical aspiration.

Recurrent respiratory papillomatosis (RRP) is a rare cause of childhood stridor which typically presents before the age of five years and results from the vertical transmission of the human papilloma virus. Genotypes 11 and 6 are commonly implicated in RRP. Following vertical transmission, the human papilloma virus (HPV) causes overgrowth of the airway epithelium which causes partial airway obstruction and the symptoms of stridor. The mainstay management is surgical debridement of the papillomata but the recurrence rate subsequent to surgery is high, such that most children will require repeated surgical procedures at regular interval. Medical adjuvant therapy can be used, but data is limited and the medications are used on an off-label basis. This case highlights the ethical considerations that need to be made when using off-label medications in paediatric patients.

The paediatric population constitutes a much smaller proportion of COVID-19 patients and seems to be less severely affected. However, the massive numbers of COVID-19 infections mean that many children require treatment in hospital. In the concerted and wide-ranging effort to discover a safe and effective treatment for COVID-19, paediatric involvement is necessary. This review aims to identify leading potential drug treatments and vaccines for COVID-19 that are being investigated with children involved. Clinicaltrials.gov, WHO Trial Registry Platform (ICTRP) and RAPS COVID-19 vaccine tracker webportals were searched for clinical trials in phase 3 that involved children below 15 years of age. Any preliminary results released were searched online. The review found 25 phase 3 drug trials with paediatric participants and 2 vaccine trials. No preliminary findings were found. Remdesivir appears to be a leading candidate drug treatment and 2 vaccines candidates, inactivated nCoV-19 (Sinopharm) and ChAdOx1 (Oxford University), are recruiting children in large phase 3 trials. No treatments are currently licensed for COVID-19 but results from numerous trials are eagerly awaited.

Ornithine transcarbamylase (OTC) deficiency (OTCD), the most common urea cycle disorder, is an X-linked genetic disorder due to complete or partial lack of the OTC enzyme. Its clinical presentation depends on the degree of enzyme deficiency and ranges from an acute neonatal metabolic crisis with a high mortality rate through to an asymptomatic adult. We present a case of a newborn baby boy who presented with poor feeding, vomiting, lethargy, and respiratory distress. Laboratory investigations revealed severe hyperammonaemia, hyperglutaminaemia, hyperalaninaemia, absence of citrulline, and marked orotic aciduria. Family screening confirmed the presence of an OTC disease-causing mutation in his mother. It was a heterozygous mutation, c.316G>A. p. Gly106Arg in exon 4.